Laserfiche WebLink
DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg h 0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 21CtiAR p 6..; ti L a. <br /> ADDRESS: 5P O �I (�rilnl BUSINESS/AGENCY: e/1N Gt~U <br /> r� �� A�{{,�,, Clty/Statelzip 00, <br /> PHONE(1): _-Z.GQ'-^t 6�i'4- 6�.Q PHONE(2): ZUQ <br /> 611 6 6 Sh / <br /> TENTATIVE*APPOINTMENT DATE: (Z- O- C) FACSIMILE: pA11'a�9 ^a09g <br /> (Please allow 10business days from date a plication submittal••Tentat/tre onlyime: be w0Nrmed) <br /> Q-CHECK BOX TO EXPEDITE REQU $105 F C H O ECk ONLY)-REQUEST PROCESSED IN 3 UUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z / -CI <br /> Electronic Information: ❑ List❑Map—Description: i <br /> FILE ADDRESSEHD USE ONLY <br /> Street# <br /> Unit <br /> Street Name City <br /> 1. 'tU uh fk° ❑ <br /> D <br /> 2. I I u {!\ S� oc S'f. Ave? <br /> 3. © Unit 2 <br /> R O �' a� '�JI1. ✓ 1 <br /> 4' ZD S sFoCIt+U. /{br d� C_ Unita <br /> 6. 3 L1 A IE 3 a� ✓ Unit �T <br /> e. 33} fi� S ✓ ❑ Unit 5 ` <br /> 9. Q UnIt6 <br /> 10. 'Z30 dl[3 �ta� Ae. <br /> Specific Date Range of Information Requested:From ESP Ilk 1 to 12/'L'38 titt' !� <br /> ,, <br /> // ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT i�SOLID WASTE FACILOYIVENICLE <br /> .OTHER CLEANUP SITE(NON-LOP) �FooD FACILITY 'iO WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑Doc KENNEL 10 DAIRY <br /> fi_�(HATARDOua WASTE GENERATOR - C3 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILn'Y ❑MOTELIHOTEL ©PUMPER TRUCKIYARDICHEM TOILETS <br /> In TATTOOISoDYPIERCING O POOtJSPA 0 Lma USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILT' ©OTHER(PLEASE SPECIFY) <br /> WELLAND 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 specie above. Select the type(s)of files from the list above by checking the appropriate l <br /> box(es). At least one file type MUST be selected. Fax to 209 464.0138 or mall 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 saltie condition as released will be reorganized by EHD staff at the expense of the applicant. i <br /> Future file reviews by the Same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> i <br /> ler <br /> EHD 48-08 8104/00 PUBLIC RECORDS RELEASE APP FORM <br /> TO 39dd NOdIa039N3 96LT6696OZ Tb:TT 8OOZ/LT/ZT <br />