Laserfiche WebLink
RMLOEIVED SAN JOAQUIN COUNTY <br />AUG 12 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRONMENTALHEhon : (209) 468-3420 Fax: (209) 464-0138 Web: vwvw.sjgov.org/ehd <br />W� <br />PERMIT/SERVICES P ELIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />PHONE (1): <br />Please allow 10 b <br />Staff will contact <br />CHECK BOX TO EXPE <br />���"' SIGNATURE OF APPLIC, <br />Electronic Information: <br />Street # <br />1. <br />2. <br />3. <br />4. <br />EHD USE ONLY <br />5. <br />Street Name <br />City <br />SM6,41 <br />s. <br />i <br />7. <br />5 ❑ Unit 1 <br />8. <br />-S�. c <br />1, <br />pry y1r'� ❑Unit 2 <br />9. <br />y 2 <br />10. <br />Specific Date Range of <br />® UNDERGROUND TANK (UST) CLEA <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORIN <br />0 ABOVEGROUND TANK <br />�] HAZARDOUS WASTEIHAZARDOUS <br />❑ TIERED PERMITTED FACILITY <br />❑ TATTOOIBODY PIERCING <br />iAr.-.. -an Coorir, PERMIT RE <br />1. List up to ten addresses in <br />box(es). At least one file t) <br />ranges will not be accepte <br />2. For assistance in identify$ <br />3. The EHD will notify the apl <br />days after receipt of applic <br />should be scheduled acco <br />4. Any file not returned in thI <br />Future file reviews by the <br />0 <br />❑ Records provided <br />EHD 48-06 <br />PHONE (2): <br />EHD LOG NUMBER <br />.1 \q �rl <br />B_USINESSIAGENCY: LV. U11 �� 9 <br />CITY/STATE/ZIP: � Iztec"-t- �f <br />FACSIMILE: sAAW <br />ness days from date of application submittal for the records to be available, ; r <br />u to arrange an appointment date and time to review the requested records. <br />E REQUEST - 30 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />r -�lP DATE �/( <br />List F-1 ❑ Map - Description: <br />-E ADDRESS <br />EHD USE ONLY <br />Street Name <br />City <br />SM6,41 <br />GLP w°M <br />i <br />c <br />5 ❑ Unit 1 <br />-S�. c <br />1, <br />pry y1r'� ❑Unit 2 <br />y 2 <br />$P 1.16-C Unit 2H <br />t <br />rh <br />100 $Unit <br />1rr ie �E]--Unit 4 <br />M, IS TE MITIGATION <br />47 <br />Unit 5 <br />to <br />Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYIVEHICLE <br />JP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ <br />❑ HOUSING ABATEMENT F1WASTE TIRE <br />REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />E] CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />ATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ 171 LAND USE APPLICATION SITES <br />POOLISPA <br />COMPLAINTIRESPONSE RECORDS F1 OTHER (PLEASE SPECIFY) <br />:ORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />:he space above: Select the types) of files from the list above by checking the appropriate <br />ph MUST be selected. Fax a 209 464-0138 or mail to the address- indicated above. Address <br />. Applications received aftdr 3:00 pm will be processed the next business day. <br />g the nature and content of EHD records, please contact EHD at the number noted above. <br />licant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />$tion. The files will be held fora maximum of five business days for review. AppoAtments <br />dingly. <br />WtW-,%je& <br />d will be reorganized by END staff at the expense of the applicant. <br />a $130 deposit prior to review. ***BOXED AREA- EHD USE ONLY*** <br />i S'w, ._1� l�_� n-,%je& C-��►dr fie( 1 ��� I6 : MLr <br />( )L% �RP V/ �9w A7l <br />PPR Complete. Staff Name: <br />711 <br />