Laserfiche WebLink
UJ/1't/LUU I IU:4U VAA X 002/002 <br /> r <5 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> LL ENVIRONMENTAL HEALTH DEPARTMENT <br /> KL �7 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> 1'44Telephone: (209)468-3420 Fax: (209)464-0I38 Web: www.sjgov.org/e 1 <br /> � 'Y r ,`�1t1>Iir PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I et JAlR!ps BUSINESSIAGENCY: <br /> p ADDRESS:-1,40 ki gkv4t-lj5� C.�( r ��cK�oly CA ciS-2.i q <br /> PHONE(1): �aDal�?r —��22 PHONE(2): FACSIMILE: � �Z s <br /> J TENTATIVE*APPOINTMENT DATE: Time: F , <br /> nil ` (Please allow 10 business days from date of application submittal-`Tentative only-must be confirms <br /> CHECK BOX TO EXPEDITE REQUEST- .00 F CASH O CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> e/SIGNATURE OF APPLICANT DATE C- d c <br /> UNIT DISTRIBUTION ❑ Uni ❑ Unit 2 O Unit 3 Ci Unit 4 CI Unit 5 0 Unit 6 ❑ Other(electron icllistsimaps) <br /> FILE ADDRESS \ EHD USE NLY <br /> Street# Street Name City <br /> dQ FAQ�T S.-reE�-t— Srr ctt' t•� r� H 61"A-'?, 01 <br /> 2. 1440 v <br /> 3. 50 <br /> 4 E. Ca.t-�w�Isr-- �t nlu AS tai <br /> s{VfiwA <br /> ` ' A <br /> p S#aokloN -- �sT o ��� <br /> !� s. C _ <br /> r � <br /> �+"^ -f :TANK <br /> A Exe l <br /> I <br /> Ee. <br /> 7.1 <br /> 8. <br /> 9 - <br /> �- �. <br /> -- <br /> x� <br /> Specific Date Range of Information Requested. o <br /> ENVIRONMENTAL H ILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOU SING ATEMENT SOLID WASTEF GILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 1:3FOOD FACILITY WASTE TIRE <br /> �y UNbERGROUND TANK(MONITORINGIREMOVAL) 11 DOG KENNEL C3 DAIRY AHAZARDOUs WASTE GENERATOR 13 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY O MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:OOPM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted–for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments st(ould 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 <br /> application 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> I(A — C�C �� <br /> 41, <br /> IY J — <br /> EHD 48-02-006 <br /> 1114106 <br />