Laserfiche WebLink
Auv]8-08 13:58 From-BROPIN AND rAI.DPIELL 916 635 8805 - T-758 P.001/001 F-537 <br /> Y <br /> 01 <br /> EHD LOG NUMBER <br /> -, SAN JOAQUIN COUNTY <br /> ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (: A 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sj9 v_ hd <br /> g i t; <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ! !!-- <br /> BUSINESSIAGENCY, <br /> ADDRESS: �,� Aff- 4kity/State0p 9Y �w r <br /> PHONE(1): =v-1S-3tww_— PHONE(2): rJr��) FACSIMILE: <br /> � I/tNTATIVE"APPOINTMENT DATE: S �sI tf' Ttit Time: 0 14-- <br /> (Please <br /> (Please allow 10 business days from date of a plicati n submittal-"Tentative only-musta6 confirmed) <br /> ❑ CHECK 13OXTO EXPEDITE RE EST-$10 E AS-H ORBHE_CKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT "' `� DATE —5%--f /57 0 8' <br /> Eloctronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> to <br /> 2 5j ���i11-4•/j�{" '� �� f� ❑ Unit2 <br /> 3. to Oq W lii�" <br /> ' <br /> unit 3 <br /> a_ <br /> FG ' do <br /> 6 a e4e580 V Unit4 <br /> 7. Q t�dE k ❑ Units <br /> g' 1. 0i D unit <br /> 10- <br /> Specific <br /> o Specific Date Range of Information Requested: From I I'I to 't'>r <br /> ENVIRONMENTAL HEALTH CEPARTMENT FILES <br /> UNDERGRDUND TANK(UST)CLEANUP SITE(LOP) O HouSING ABATEMENT ©SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINOIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C3 MOTELIHOTEL 0 FumPER TPRUGKIYARDICNEM TOILETS <br /> M TATTOOIBODY PIERCING E7 POOLISPA O LAND usE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY 0 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 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 atter, <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHO 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 rive business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A filo 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 fila not returned In the same condition as released will be reorganized by EH D staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$10S deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46.06 6/44/D8 PUBLIC RECORDS RELEASE APA FORM <br />