Laserfiche WebLink
yr luleUVO 10:04 VAA [a001 <br /> DATE RECEIVE EHD LOG NUMBER <br /> PD), rn �`�I��� SAN .lOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '- <br /> 7 2009 600 East Main Street, Stockton, CA 95202-3029° Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org <br /> 1w7( NV F" 1<ri��T �jEA0K ((„/// <br /> ,.l PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BrI4f1A t < BUSINESS/AGENCY: LE1(.41ve,i 6M1 L''LLTI <br /> yNlT <br /> ADDRESS: l { Dyj 00i City/State/Zip I ILVI N [A "l ua l i d <br /> PHONE(1): "l la$I Q'L87 PHONE(2): q4y-3q4-23Gb FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: 1-27-0 9 Time: !P tA, <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be honfirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7-/i.-QI <br /> Electronic information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ <br /> nit 1 <br /> 1 5' W, L�l' 'o t ca A? Aga T <br /> 222 t4. tAAi e( an tit ❑ Unit2 <br /> 3 7(e N. Un:ex Ro( <br /> 4. 3 Ot' ffla�n S '�" 3 G t 5`40":IJ"dii Un" 3 I� <br /> ad ` ► <br /> 6 Unit 4 <br /> 7. <br /> ❑ Unit 5 <br /> 0 <br /> �. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From Jh C!Vq!61�4 to tpr eX <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ql /�� � <br /> 1p(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT 11 SOLID WASTE FACILITY/VEHICLE1r <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)0C ❑ DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT -C/ <br /> TIERED PERMITTED FACILITYN/ ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑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-5:00PM - 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 /> �. _ �, I R N <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />