Laserfiche WebLink
I E 17111! �y� Nr� EHD LOG NUMBER <br /> s i 1 I IIkttJJ1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC I 1 '1009 600 East Mair) Street,Stockton, CA 95202-3029 <br /> Telephone: (209)468.3420 Fax: (209)464-0138 Web:vv�Gl W.sjgov.orgleh <br /> 1 q7c) <br /> ENPP CiHTI€ F;i #IGESPUBLIC RECORDS RELEASE APPLICATION <br /> +fi+ nn I�I�R.T.�C-`ASIS TGAi�r.-�T••-�I� -+...'rY' <br /> APPLICANT: _BUSINEMAGENCY: <br /> AODRE,39: —faS1LL.rnGdO)Zyl���_._ - ...... Gltyl$tptaf2ip ,Qf�tr.�ltti�l,,{�T��� <br /> PHONE(1): _ 7J�`7bI, 11a0C? PHONE(2)- FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: __ !'� ��Q-��r _ Tlmo: 'A:CSU <br /> (Please allow 10 business days from date of appllcatlon Submittal-"Tentativr only-must Do aonflumd) <br /> CHECK BOX TO EXPEDITE REQUEST $ d IF!21�JsHcHECK ONLY)-REQUEST PROCE85E D IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic tnforfnation: []List[]Map–f]escrlption: <br /> FILE ADDRESS EHD USE ONLY <br /> _ Sttuat TEt Street Namo City © Unit 1 <br /> z, ` ❑ Unit 2 <br /> 3. <br /> 4. I LJ unit 3 <br /> --- Unh 4 <br /> 7. <br /> - ❑ Unit 6 <br /> Specific Date Lange of Information Requested:From ! to __Rc i70 17 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )XVNDcRr,RoijNo TANK(UST)CLEANUP SITE(LOP) 13 Housm i ABATEMENT Q.q(1op WAsn FACILITYIYEHICLE <br /> OTHER GLF.ANUp SITE(NON-Lag) 0 FOOD FACILITY n WASTE TIRE <br /> 0 UNbERGROVN0 TANK(MONIToPiNGIREMOVAL) O Doo KENNET. ❑DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> E3 TiERED PERMITTED FACILITY Cl MOTB)HOTEL ❑PUMPER TRUCKMARolCHEm TOILETS <br /> TATTOWBODY PIrkciNa M PoOLISPA Q LAND USE APPOIDATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PENMI I RECORDS ARE AVAFLABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-6.00rm -E%CLUPINO 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(sa). At least one file type MUST be selected. Fax to[2091464-013$of..nmil 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 /> 3:86 pm will Ire processed the next business day, <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A fII9 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 avalfable. <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 name applicant may require a$105 deposit prWrto review. <br /> - EHD USE ONLY <br /> EHD 48-06 8104106 PUO(IC RECORr)S RFI,FASF ARP FORM <br /> T abt?d d50:F0 800Z'TT DEC <br />