Laserfiche WebLink
rV J• LVV) Y.V;I lrl \LL 1111 L'-'.i LI AV. I7L9 I . I <br /> �C AI D tHD Lvv NJMBER <br /> �I,If\\��fI�U SAN �OAQUIN COUNTY <br /> EtfVIRONMENTAL HEALTH DEPARTME'N'T` <br /> NUV 0 9 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvnv.sjgov.or4 <br /> EHF{RO�I11EfuTHEALT�����BUSINESSIACIENCY: <br /> H 35 <br /> PUBLIC RECORDS RELEASE APPLICATI 'O'N, �r ' 1APPLICANT: _. � t^ � Y�tU�ILN.K�G'{l —ADDRESS; . lStatelYlp I�OICM,�.I�Y�Mi.IA 1� CJrjZ� <br /> PHONE(,): Cl�lp-3�tP-'I.7O ( PHONE <br /> �(22)�_,t,., FACSIMILE: a((p-3VV--70120 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of applit4tion submittal-'TontaUve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE ,�U^EST-$105 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ( A &4,c S DATE 10 /2,01Q9 <br /> Electronic Information: ❑ List❑ Map—Description' <br /> FILE ADDRESS EHD USE ONLY <br /> 8treeta Stroot Name city <br /> 1. �+I'I�l � iv'�'1 ❑ Unitl <br /> 2. Alt 2 <br /> 3. t \ L7 Unit (�3 v �, <br /> 5' ❑ Unit4 <br /> 6. I <br /> ❑ Units <br /> a. J <br /> 8• ❑ unit 6 <br /> 1 D. <br /> Specific Date Range of Information Requested: From Fle to <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -ERGROVNOTANK(UST)CLEANUP SITE(LOP) 0 HOUSI NG ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> cR CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY E3 WASTE TIRE \ <br /> NOERGROUND TANK(MONITORINOIREMOVAL) 0 DOG KENNEL r1 DAIRY <br /> AZARDOUS WASTE GENERATOR MCHICKEN RANCH W EWATER TREATMENT PLANT <br /> •TIERED PERMITTED FACILITY M MOTEL/HOTEL MPFR TRUCK/YARD/CHEM TOILETS <br /> 4 TATTOO/BODY PIERCING 13 POOLISPA LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIPY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY•FRIOAY 8t00AM- , _• EXCLUDian!I0AY8 <br /> 1. List up to ton addresses In the space above. Select the typo(&)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. FAX to(208)464 0178 or mall to the address Ino cat d above Address <br /> ranges will not be accepted—for additional assistance with filo 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 revlew, 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 48-06 8/04/03 PUBLIC RECORDS RELEASE APP FORM <br />