Laserfiche WebLink
9M 'IN M 0l ZIE '6Z 'unr mill paAIaDa� <br /> EI V LP:DSAN .10AQUIN COUNTY EHD LOG NUMBER <br /> Aft <br /> AJ'N 2 9 ?01Z ENVIRONMENTAL HEALTH DEPARTMENT IF <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/Ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: kcvi til nd y k4 <br /> ADDRESS: CITY/STATEIZIP; ,,� �q <br /> PHONE(1):(�� �3'a.�3�<g PHONE(2): FACSIMILE: <br /> TATAT/VE"APPOINTMENT DATE: .2 h 0, Time: :OO 0,M <br /> (please avow 0 business days from date o appli ation submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE EST-$1 5 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ao <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street k Street Name City <br /> ❑Unit 1 <br /> Ct <br /> 2. <br /> 3 Unit 2 <br /> 4. <br /> 5 ❑Unit 3 <br /> 6. 2— Una 4 ' <br /> 7. <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> ❑UNDERGROUND TANK(MONfrORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIER£D PERMITTED FACILITY MOTELIHOTEL Q PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA <br /> ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDIN(3 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. <br /> EHC USF ONLY <br /> ■ <br /> ■ I <br /> EY.D 4V1'6 ■ <br /> alvt� ■� <br /> ■ <br /> ■ <br /> TM 'j WV fi� :01 TXd 71u-F7-Nm■i <br />