Laserfiche WebLink
fke()Eb0" <br /> 14 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> %-tQA 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> � ��0� ephone: (209)468-3420Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION " r r r ? : <br /> APPLICANT: I im �iy►ir� BUSINESS/AGENCY: ESI_ (on 54111 <br /> ADDRESS: ZS6-1 5104 way � CITY/STATEIZIP: "'eAy, <br /> PHONE(1): -'(c(• 3057. 1&Zq PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tenfadve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUES EE(C R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name / City <br /> ❑ Unit 1 <br /> 141E <br /> 2. 1u(5-(95' 1 !( �G� 1 aIlnitZ 1 <br /> t&L9 Rolf <br /> 4. 1/ ; .1 <br /> 5. /❑ Unit 3 'C.� <br /> 6. <br /> i❑ Unit 4 <br /> 7. <br /> 8. F Unit 5 <br /> 9. <br /> O� <br /> 10. �( <br /> p unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY 2SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(HON-LOP) [�HOUSING ABATEMENT WASTE TIRE <br /> [UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> Q ABOVEGROUND TANK 0 CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ZJ TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING RCOMPLAINTIRESPONSE RECORDS Q OTHER(PLEASE SPECIFY) WkIL I- <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 feast 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 hot returned in the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 914/'12 <br />