Laserfiche WebLink
n <br /> S <br /> EHD LOG NUMBER 15 j AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT evq <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> 4 LJ116 <br /> Telephone; (209)468-3420 Fax: (.209) 464-0138 Web: www.sjqOv_O1 10% <br /> li PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 13USINESVAGENCY:.-- 9!�g_ <br /> ADDRESS. Na4ttA _tll� Cr .---."' <br /> a'kttr CITY/STATEIZI P.- CeydtLw. Qt 1q7b <br /> PHONE(1):510-3 t,5 4a (- ? <br /> PHONE(2). 1�o --RS'Z -446 t' FACSIMILE. -1 L& -RA-' <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date ol'apptication submittal-*Tentative only I MUSk be confirmed) <br /> ❑CHECK 8OX TO E'6EDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINE55 DAYS <br /> SIGNATURE Of=APPLICANT DATE <br /> ElGctronic information:11 El List El Map-Description, <br /> 7—� Il FILE ADDRESS EH 0 USE ONLY <br /> # Street Name city <br /> e ❑Unit I <br /> CA <br /> 2. <br /> 7_1'1 <br /> 4. <br /> � <br /> 5it3 <br /> 6. <br /> E01<1 4 <br /> 7. <br /> 8. <br /> D Units <br /> Lo El unite <br /> $Per,ifjcdata Range ofinforrnLationReques:ted., From 11,74; to V <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ZUNDF-RQRQUNv TANK(UST)CLEANUP SITE(LOP) LJHOUSINo ABATEMENT [:1SOLID WASTE FAC[LrTYNERICLE <br /> THER CLEANU F SITZ;(NON-LOP,) [I r000FACILrTy D WAsTETIRE <br /> MNIJERGROUND TANK(MONITdRimGIREMOVAL) ElDoG KENNEL ElVAJRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RAxCH F-1 WASTEWATER TREATMENT PLANTEl TERED PERMITTED FAclUTY morELIHOTEL ❑ <br /> 0PUMPEK TRUCWYARDICHEMIGALToLETS <br /> ❑TATTOOIBODYPIERCIN(a ❑POOLISPIA <NO USE APPLICATION SITES <br /> MEDICAL WAsTFFACILITY P <br /> OTHER(PLEASE SPECIFY) I <br /> WELL AND SEPTIC Pr:RMITIRECORD$ARE AVAILAEILE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5*OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above, Select the typo(&)of files from the list above by checking the appropriate <br /> box(cs). At least-one%)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 addriesses,contact the EHD. Applications received after <br /> 3:00 pm Will be prQ0*0Sed the next business day. <br /> 2- The EHD will notify the 'applicant I any EHD files exist.An appointment for review will be confirmed approximately ton(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 av,6r4iiiUly, <br /> 3. A file that is actively baing worked an by EHD staff may not be immediately available for review. Anew appileadonmaybe <br /> submitted when the file is available. <br /> 4- Any file not returned In the same condition as released will ba roorganizod by EHD staff at the expense of the applicant. <br /> Future file revte"by thf6 same applicant may squire a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3426. <br /> — EHD use VNLY <br />