Laserfiche WebLink
Print Form <br /> Submit by Email <br /> DATE RECEIVED 0 ~ <br /> Contact: SAN JOAQUIN COUNTY <br /> Yvette ENVIRONMENTAL HEALTH DEPARTMENT <br /> direct phone 600 East Main St_ Stockton, CA 95202-3029 <br /> 209-468-3421 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> or Cheryl Field PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: BSc RT <br /> ADDRESS: ZS`O(U .. .��r.n `l�tuL_-' CITYISTATEIZIP: <br /> PHONE(1): (q2 PHONE(2): FACSIMILE: (2zf <br /> TENTATIVE"APPOINTMENT D TE: Time: <br /> (Please Allow 10 business dVyfrom date of application submittal-•Tentafive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDfTG REQU S - 15 F (CASH OR CHECK DNLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE to l 7-,n C I <br /> Electronic Information: Lis WMap--Description: l—e 2 -P t fka - a C c I-Lo taw cw- <br /> FILE ADDRESS EHD USE ONLY <br /> Street:r Street Name City Ej Unit 1 <br /> 2. Cc✓ (.O /t�e� c c ❑Unit 2 <br /> 3. <br /> 4. — -- - ❑Unit a <br /> 5. <br /> 6. <br /> ❑Unit 4 <br /> 7. <br /> 8. <br /> — - <br /> ❑Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMEhTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ZFSOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY �WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> J HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH [KWASTEVJATER TREATMENT PLANT <br /> ❑TIERED PERM11TED FACILITY ❑MOTELIHOTEL M PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> jR MEDICAL WASTE FACILITY ❑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 tip to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 1209)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 he 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 deposit prior to review. <br /> 6. if you need further assistance, please contact Diane Martinez,at(209)468-3425, <br /> EHD USE ONLY <br /> EHD 48-08 8127100 <br />