Laserfiche WebLink
DATE RECEIVE EHD LOG NUMBER <br /> $AN .IOAQUIN COUNTY �, • n� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 0 2 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232"44TaiaLf <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> �I•tvhnrtF�I TALi;EAci PUBLIC RECORDS RELEASE APPLICATION <br /> ,�-pt emrCi^rn nrv�C <br /> APPLICANT: I1\4 Soyru ^� LtUPI �''IGr "i3"USINESS/AGENCY: ��// � 11 <br /> ADDRESS: 382E (31101 ;L-_ 14" __ CITY/STATEIZIP:�J�OO.P Qu rUU ( C/T ? 5 3 <br /> PHONE (1): �Zg �rj�—(�3�_ PHONE (2): 97S= S'1373 FAX OR E-MAIL: aA-0seugqrrv. <br /> Please allow 10 business days from date of application submittal for the records to be availa le. r,V-A <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> KCHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1 ? Z <br /> Electronic Information: [$List ❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 1' 27I� Eccsi- mthor AL4Avtzyj �rp� �(farry-�o <br /> ❑Unit, <br /> 2 <br /> agos .nn'h r I.Dp } k srrs-LO <br /> 3. 3 ^ h of A�nv-� L-0? 91-CO o unit 2 12. . <br /> 4. 3310 . l qD Ck,41yjL,f9 F kAartti -CO [I Unit 2H (rpy )v� <br /> 5. d-1 Lk E . S Gh"yl ('a r- CO Ly Unit 3 'J <br /> 6. a$ ( S 1-9 - LD 1 In`6­1jt <br /> 7. N-ulen (8 y4nit4 <br /> 8. <br /> 0�,tN1 ®SITE MITIGATION <br /> 9. ( J,- �-1rj <br /> 1D El unit s <br /> Specific Date Range of Information Requested: From IQ�]� to f2o 19� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑WASTE TIRE ❑DAIRY,POOLISPA <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATroolsoDY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑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 un 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.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 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$130 deposit prior to review. <br /> ""BOXED AREA-EHD USE ONLY" <br /> ('aA lAti LOP C (¢ LZ <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br />