Laserfiche WebLink
08/21/2009 FRI 9: 50 FAX 203 998 6404 S R Simplot Engineering 12001/001 <br /> IN AL EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> i 2009 600 East Main St. Stockton, CA 95202-2708 <br /> T Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> P u. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l�y�VJ ,N1 UG!! _ BUSINESSIAGENCY: <br /> ADDRESS: d. CITY/STATE/ZIP: /(( �).c:;> : rA �S > v <br /> PHONE(1): 7')( c/7 PHONE(2): JO%- /% FACSIMILE: S"b- <br /> TENTATIVE'APPOINTMENT DATE: Q Time: q.'36 Am <br /> (Please allow 10 business days from d to o application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE IZ/�` <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name i City ❑Unit 1 <br /> 2. Unit 2 <br /> 3. I <br /> _._..... _.............----.......-._..... ...__...__.-__.._.__ _._._......_._........... <br /> ___.).__._.__._..._....._.____ <br /> 4. nit 3 <br /> 5. i <br /> s _ <br /> 7 _..__....._.__________._....____ <br /> - - <br /> 7. <br /> ❑Unit_5 <br /> 9. <br /> ­ -.­­­.­­..._..............__..___.._......___._._._._._....-----.-_._.__._..__-.. .._...__...____....._.................... <br /> 10. 1 1 1 ❑Unit 6 <br /> Specific Date Range of Information Requested: From �T/HD�'O_A_RTMENr <br /> to231ENVIRONMENTAL H A FILES <br /> !UHAZARDOUS <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) F1DOG KENNEL ❑DAIRY <br /> WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY %OTHER(PLEASE SPECIFY) /goy 4Je// palei44 <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 /> r�fs��s vvitl n�stb�a` tett=YbraAditional"as"s"istance withTiile addfesses,con-t cl"the EHD..-App-lica ions received"time <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$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> 7---if you need further assistance please contact Diane Martinez 0 (209,468-3425 directly. Thank You*** <br />