Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov. d D <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ,I <br /> APPLICANT: ts4sE.1RYBUSINESS/AGENCY: rtriC a }�J� <br /> ADDRESS: ZCJ� CLWiW YI City/State/Zip '1AS\IES2 <br /> PHONE(1): r6. 01'6S PHONE(2): JID. FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT f---''t. DATE 1?I4 ±y ya <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> a ❑ Unit 1 <br /> 2, 11 <br /> Unit 2 <br /> 3 <br /> 4 Unit 3 <br /> 5. Pv <br /> - ..-....-- — nit 4 <br /> 6. <br /> 7. ❑ Uni <br /> 8. <br /> L9. _ ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From OOG to �� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ©'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 13 SOLID WASTE FACILITYIVEHICLE <br /> IJ OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> ES UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> Q HAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> OO TIERED PERMITTED FACILITY 13 MOTEL/HOTEL 0. UMPER TRUCK/YARDICHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOLISPA LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:00PM -EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />