Laserfiche WebLink
EHD LOG NUMBER <br /> DAQECEIVED.___ <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JIJ[. 2 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> CIZ& <br /> APPLICANT: L) C BUSINESSIAGENCY: rim <br /> ADDRESS: <br /> ADDRESS: Au-c CITY/STATE/ZIP: <br /> PHONE(1): b b Z PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application.submittal-*Tentative only-must be confirmed) <br /> F1 CHECK BOX TO EXPEDITE REQ 5 FEE(CAS OR CHECK ONLY)-REQUEST PROCESSED IN3BUSINESS S <br /> T 25 FEE(CAS <br /> U� <br /> SIGNATURE OF APPLICANT ­ - - �?v' (7_J)14%kf?a'i4_<__ DATE <br /> Electronic Information: U List 0 Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> [ Street# Street Name city it 1 <br /> 2. El Unit 2 <br /> 3. <br /> 4. p�Ulit 3 <br /> 5. 'File ell, <br /> 6. PMV '7&ftl 5 -6/unit 4 <br /> 7. Z.1-11 <br /> S. El Unit 5 <br /> 9. <br /> 10. --E-3 Unit_6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMET AL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FAcILITYIVEHICLE <br /> M OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT E WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL E WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTELIHOTEL E PUMPER TRUCKfYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPA LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS UOTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE OR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(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 /> 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 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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 914112 <br />