Laserfiche WebLink
UA I L Kt ;tIVtU tHU LOU NUMBER <br /> FF�� � E <br /> � > SAN JOAQUIN COUNTY <br /> I—'i �� DD ENN DNAIENTAL HEALTH DEPARTA�IT <br /> b ( `�1___9 U_, <br /> 600 East Main Street, Stockton, CA 95202-2708 <br /> d 5 2004elephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjg . g h( <br /> E1 V1'`i"i�IV1F , ALTP,, UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: b 1, BUSINESSIA ENCY: E41 <br /> ADDRESS: f� <br /> PHONE(1): S� Z — ! �� PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application bmittal-"tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE REQUEST.$9 . FEE(CA OR ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z' b <br /> Electronic Information: ❑ List Map– Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street NameCity ❑ Unit 1 <br /> 6 00 Ice 7 <br /> 2. 'Q &0 9 •, Unit 22 <br /> 3. <br /> 4. ❑ Unit 3 <br /> 5. ❑ Unit 4 <br /> 6. <br /> 7. ❑ Unit 5 \� <br /> 8. <br /> 9. ❑ Unit 6 <br /> 10. <br /> Specific Date Flange of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br /> d OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 11 DOG KENNEL M DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C] MOTELIHOTEL 11 PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOIBODY PIERCING 0 POOLISPA X LAND USE APPLICATION SITES <br /> 171 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. T– x"111-*©tify-the appHcant-if any-E+KY4ites-exist.--ln-appsintment-for-r ' rmedappruxtmately Cert( -0) <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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** assanceeasecony. *** <br /> EH048.06 9/14/2005 <br />