Laserfiche WebLink
EHD LOG NUMBER <br /> Cy' EED SAN JOAQUIN COUNTY �� �qe <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP ® b 2Qi5 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 4eCE✓ C J c, V- BUSINESS/AGENCY: ��c��� F>7a i �c <br /> ADDRESS: I r) C(!)(.k12 I c 1 ! '- /ice CITY/STATE/ZIP: GcK�r� c pSZ�� <br /> PH0NE (1) 23-175-3;- PHONE (2)� � ;'-�-,_ 1 5 FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQ ESTT--$1 FEE( OR CHECK ONLY)-REQUEST PROCESSED IN <br /> IN3BUSINESS DAYS <br /> SIGNATURE OF APPLICANT G' DATE /,( q- - /— <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name city <br /> 2. (, .� '2 T 1 ❑Unit 1 <br /> 3. �Ur k a A R9v/�taCl C� ❑Unit 2 <br /> 4. ❑ Unit 2H <br /> 5. <br /> 6. Unit 3 <br /> 7. Unit 4 <br /> S. SITE MITIGATION <br /> 9. <br /> ✓ � <br /> 10. ❑Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ©ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ,x❑HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> '©.TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING jRtCOMPLAINTIRESPONSE RECORDS ❑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.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 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$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 46-06 711115 <br />