Laserfiche WebLink
P-=T EHD LOG NUMBER <br /> f`TER CEIY D�k� < <br /> 7 2 � SAN JOAQUIN COUNTY <br /> • <br /> DEC 2 3 2015 18ENVIRONMENTAL HEALTH DEPARTMENT 68 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENMRD;(',Ell UAL HE„LTI <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: VAUN BUSINESS/AGENCY: Ge�\S( Ft RSSDUR(ES, 1h1L. <br /> ADDRESS: Q O DIC 33 L CITY/STATE/ZIP: K ell I�'LC <br /> PHONE(1}: _C}jfL� �t��� PHONE(21: FAX ORE-MAIL: `rG��11�� %JL\C d\ASSDC\A S. <br /> Please allow 10 business days from date of application submittal for the records to be available. COMv� <br /> Staff will contact you to arraan ee an appointment date and time to review the requested records. <br /> ❑ <br /> CHECK BOX TO EXPEDITE RE UES -6130 FEE �AS OR C CK Y REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT /t G DATE 1l 3 1� <br /> Electronic Information: ❑ List❑(Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name -r� city <br /> Unit I <br /> F2. 2Vib� S NW>y '\% FRS kbt R-D J <br /> 3 3 l 00H1\S �V S roc '1 o N [I Unit 2 <br /> 323 <br /> 4• ti�2h S N i�l�ly11\LA ��ONS�C� �D STnC�TbN ❑t,nit2H <br /> 5. 2� 01 S �w `1�1 �gaNTPc b S Co c� Cb��11 nit 3 <br /> • 5. 3112rr,^� \A kA\ /V/�D Unit 3HM l <br /> ITE MITIGATION <br /> 9• ❑Units <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> rryy <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑SOLID WASTE FACILITY/VEHICLE <br /> 'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL <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 TRUCK/YARD/CHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> ®TIERED PERMITTED FACILITY NrCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ANF5:00PM(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(2091464 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 /> • <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br />