Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> D <br /> ENVRONM ''"NENTAL HEALTH DEPARTM T <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> 1fi Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 47 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A4Z BUSINESSIAGENCY: �✓ <br /> ADDRESS: —., � �'Y- [ o� '��� � <br /> LZ <br /> PHONE(1): amt/ ! 3 e� r�7 PHONE(2): FACSIMILE:!Z1�1' <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST 95.00 (CASH OR CHECK ONLY)-REQUEST PRO D U <br /> SIGNATURE OF APPLICANT �...� T <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. a oo Z Gv <br /> 3. u= <br /> I� Unit 3 <br /> 5. ❑ Unit 4 <br /> 6. I R I <br /> 7. J <br /> ❑ Unit 5 <br /> 9. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILnYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> 0 UNDERGROUND TANK(M ONITORING/REMOVAL) 13 DOG KENNEL 0 DAIRY <br /> ir3 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> 13 TATTOOIBODY PIERCING �OOUSPA ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY Z Yo OTHER(PLEASE SPECIFY) 51"4 ��lw��/ fN/k4 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM I XCLUDING 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4"G 9113rz00e <br />