Laserfiche WebLink
L��RECEIVED EHD LOG NUMBER <br /> RMCIMVEDD <br /> SAN.JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 q <br /> 2006 <br /> AI lIa � 2 Telephone: (209)468-3420 Fax: (209)464-0138 Web: wwNv.sjgov.org/ehd <br /> ENVIRONMENT HEA!TH PUBLIC RECORDS RELEASE APPLICATION <br /> r <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: 3 <br /> PHONE(1) ��������PHONE( ): O Z� FACSIMILE: )V —S:A q <br /> TENTATIVE"APPOINTMOAXTE: Time: <br /> (Please allow 10 busine ays from date f application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE T-$9 0 FEE C O HECK ONLY)-REQUEST PROCESSED IN 3 USIN SSD YS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Uni nit nit 5 ❑ Unit 6 ❑ Other(electronic lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Namp Cit <br /> none_ <br /> 2. > 1 <br /> 3. [)1 I <br /> 4. f7 t t �- <br /> 5. <br /> 7. <br /> 6. <br /> 8. _ <br /> 10. <br /> Specific Date Range of Information Requested: From to J , <br /> AT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCHJ+ ❑WASTEWATER TREATMENT PLANT <br /> M <br /> ❑TIERED PERMITTED FACILITY OTEL/HOTEL CO: C£I ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOo/BODY PIERCING ❑ POOL/SPA �❑LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY 13 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$95.00 deposit prior t eview. <br /> — – , <br /> EHD 48-06 <br /> 8///06 <br />