Laserfiche WebLink
DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVOONMENTAL HEALTH DEPARTbao4T <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ G j l F� y Com/ BUSINESS/AGENCY: Qin Q o jp r I i <br /> ADDRESS: 3TY-3 CITY/STATEIZIP: GLt,CO Ck+ grl?2-6 <br /> PHONE(1): S3v -3VS-- T-06S PHONE (2): 830 - S1 r I FACSIMILE: S3C - Ns= Sl 3U <br /> TENTATIVE'APPOINTMENT DATE: 727 / 1 i o f Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative onlyr <br /> -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE ABHOR CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �r�� - DATE 7 ��/ - <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Strad/ &rah Name City ❑unit 1 <br /> 2. <br /> 3. <br /> ❑unit 2 <br /> a <br /> ❑Unit 3 <br /> 5. <br /> _ dun8 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑UnH 6 <br /> Specific Date Range of Information Requested: From ) / ) 1 1 to -7/.2 -7 / 2v t L <br /> ENVIRONMENTAL HEA TH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILRYNEHK:LE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEIIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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$125 deposit prior to review. <br /> 7 L - <br /> -- <br /> Elio 4e-06 mu>> <br />