Laserfiche WebLink
�..• EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, 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: /j r�(•/ F� �/ BUSINESS/AGENCY: t.AI rx <br /> ADDRESS: x{335 I�1 /�l�Lt ��CIiF �VL� S�C �D �f t �vtc� (A oT 77 ZZ. <br /> PHONE(1): �75� 2`��—�OS4y PHONE(2): FACSIMILE: <br /> TENTATIVE'`APPOINTMENT DATE: ��Z> �%� Time: ' <br /> (Please allow ten business days from date of application submittal-*Tentative only-must be confirmed) <br /> 71 CHECK BOX TO EXPEDITE REQUEST $98.00�0 FEE(CASH OR C ECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l 4��- DATE `J'U 23 <br /> Electronic Information: ❑ List ❑ Map -Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> s0 5• <br /> 1 ❑ Unit 2 <br /> 2. <br /> 3. <br /> 71 Unit 3 <br /> 4. <br /> 5. <br /> ❑ Unit 4 <br /> 6. <br /> 7. _ <br /> — ❑ Unit 5 <br /> a. _ <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to 20c) <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> W UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY <br /> ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 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 above address. Address ranges will <br /> not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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 $98.00 deposit prior to review. <br /> EHD USE ONLY <br /> -- - PUBLIC RECORDS RELEASE APP FORM <br /> EHD 4"6 10/29107 <br />