Laserfiche WebLink
Apr 23 10 09: 47a Krazan & Associates 559348 9U p- 1 <br /> u u� �tlyD <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �Pf,z 3 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> NT 600 East Main Street, Stockton, CA 95202-3029 <br /> ENDEWENT FIBEERESLT HTelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> R <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .T6-9.L.. kepnHw,. BUSINESS/AGENCY: Y IP-R-aNN+ XSSOC(FF( S� me . <br /> ADDRESS: _21S W- [)A 14711A_A-V. City/state/Zip CkDJLS CA 9 3F,,,/``.A <br /> PHONE(1): E54. .345R . aaCb PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: (-NSP-:P 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 DATE L�jac�((l() <br /> Electronic Information: ❑List ❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑ Until <br /> 2• I_qq4L r' nit2 <br /> 3. <br /> 4, ni 3 <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> $ ❑ Unit 5 <br /> 9. <br /> Unit s <br /> 10. <br /> Specific Date Range of Information Requested: From Pru_ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINGADATEMENT {q�SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SHE(Nom-LOP) 171 FOOD FACILITY RWASTETIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH %WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKfYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am-5:ODPM - 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 4M6 8/04100 PUBLIC RECORDS RELEASE APP FORM <br />