Laserfiche WebLink
SAN J OAQUIN COUNTY <br /> EN ONMENTAL HEALTH DEPART <br /> 600 East Main Street, Stockton, CA 95202 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov / <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D %'^ ktv'- <br /> BUSINESS/AGENCY: <br /> ADDRESS: '�yV�D !d. �r(> A4I Ste%-- QtVd, C . 1 U,vk_%X CA 4 S3,18 Z <br /> PHONE(1): Zo5 C�fo'� ' to��`{ PHONE(2): ?*� C - Z-"-SZ FACSIMILE: TC31 W01" (0(0 15 <br /> TENTATIVE*APPOINTMENT DATE: 'a 13 cl'"- Time: 1"1 O Q <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE _+IZ5_N" <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS `EH E ONLY <br /> Street# Street Name City I,{ 0 ( ❑ <br /> !� 1. 'L�-1 t�' (.�2,Sf L•b�. t S E'�otk b�1 � F� •�� unit 1 <br /> Sk V�`^ V4�r'(C>1 /fig �1,� ❑ Unit 2 <br /> 3. <br /> 4. <br /> 5. <br /> 6 00runit 4 Vr <br /> 7. <br /> $ ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From Zc�QkA to V4%A3" <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> >(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> El THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> EI TIERED PERMITTED FACILITY 13 MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 1:1 MEDICAL WASTE FACILITY 0 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 appropriate <br /> box(es). At least 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 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$95.00,deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 5/16/2007 <br />