Laserfiche WebLink
C" ' qQUIN c:UUN I YPUBLIC HEALTH—RVICES <br />*.,cNVIRONMENTAL HEALTH DIVIS-i,..,„ <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />JUL 2 5 2000 (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS <br />PHONE <br />TENTATIVE' APPOINTMENT DATE _ <br />{Ptaa— give 7 to !v <br />CHECK 60X TO EXPEDITE RE <br />SIGNATURE OF APPLICANT <br />BUSINESSIAGENCY <br />A U/y <br />4.S` <br />TIME 11'160 /JV- — <br />from date of application submtttat) <br />FEE - REQUM PROQESSED IN 3 BUSINESS DAYS <br />DATE <br />f)(1. <br />FILE ADDRESS— <br />rxv��rr��Wrir.� <br />m <br />ME_ no �� <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING AFAATEMENT 11 SOLID WA5TE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />AZARDOUS WASTE GENERATOR IJ CHICKEN RANCH O PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELJHOTEL 0 PUMPER TRUCK(YARD/CHEM TOILETS <br />TATTOO(BODY PEIRCING❑ PODL(SPA ❑ LAND USE APPLICATION SrrES <br />r <br />MEDICAL WASTE FACILITY— �J! I ��{� M PUBLIC WATER SYSTEM 0 OTHER (PLEASE $PECIFY ABOVE) <br />1. List up to ten addresses in the spacd above. Select the type(s) of fifes from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />adOress indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of application_ The files <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3_ A file that is actively being wonted on by EHD staff may not be immediately available for review. A new <br />appllc<ation 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 <br />of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Application$ received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />EH 00 u ovosraa <br />2S - <br />