Laserfiche WebLink
OG/22/2004 11:59 303789 <br />TECHLAW INC . <br />PAGE 02/0 <br />EHD LOG NUMBER <br />DAT IIIyEO SAN JOAQUIN COUNTY <br />�J J ENVIRONMENTAL HEALTH DEPARTMENT <br />JUN 2 2 2004 304 E Weber Ave 3.d Floor Stockton, CA 95205 <br />(209) 468-3420 Fax: (209) 464-0138 Web: v;ww.co.san-joaquin.ca,us/ehd <br />10 <br />ENVIRONMENT hLAi_I H <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />PHONE: <br />BUSINESSIAGENCY: _Tle ^11 (2 VV - <br />TENTATIVE" APPOINTMENT DATE:I e vl IQ. TM+e <br />(Please allow 10 business days from date of appileatlon Submittal) <br />C3 CHECK BOX TO EXPEDITE REQUESTA. $9100 PEE-REQUESTPROCESSED IN 3 BUSINESS PAYS <br />SIGNATURE OF APPLICANT I 1 D 'lI CYFCt�n � DATE (0 r IZ2�2 rP q <br />Department Use Only <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />JCC OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />0 TIERED PERMITTED FACILITY <br />13 TATTOOIBODY PIERCING <br />O MEDICAL WASTE FACILITY <br />UNIT <br />❑ Unit 1 <br />Unit 2 <br />Unit <br />C C <br />Unit 4 <br />5%05 <br />2 jzOk <br />13 HOUSING ABATEMENT <br />FOOD FACILITY <br />SOLID WASTE rACILIT"YO- I <br />❑ SOLID WASTE VEHICLE <br />O DOG KENNEL <br />13 CHICKEN RANCH <br />O MOTELIHOtEL <br />O POOL/SPA <br />O DAIRY <br />0 PKG TREATMENT PLANT <br />M PUMPER TRUCKIYARDICHEM TOILETS <br />13 LAND USE APPLICATION SITES <br />13 OTHER (PLEASE SPECIFY) <br />,Itt11ra. <br />.'P <br />J•.rrl <br />r <br />A <br />r <br />rN&M <br />1 1NEM <br />I V <br />• <br />I f <br />���' <br />_ <br />..�IWA <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />JCC OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />0 TIERED PERMITTED FACILITY <br />13 TATTOOIBODY PIERCING <br />O MEDICAL WASTE FACILITY <br />UNIT <br />❑ Unit 1 <br />Unit 2 <br />Unit <br />C C <br />Unit 4 <br />5%05 <br />2 jzOk <br />13 HOUSING ABATEMENT <br />FOOD FACILITY <br />SOLID WASTE rACILIT"YO- I <br />❑ SOLID WASTE VEHICLE <br />O DOG KENNEL <br />13 CHICKEN RANCH <br />O MOTELIHOtEL <br />O POOL/SPA <br />O DAIRY <br />0 PKG TREATMENT PLANT <br />M PUMPER TRUCKIYARDICHEM TOILETS <br />13 LAND USE APPLICATION SITES <br />13 OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091464.0138 or mail to the <br />address irlicated &Rove. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />lxvs edays after receipt of dplThe <br />efiles <br />approximately <br />for amaximuof fie business days forreview. Appointments should scheduled <br />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 <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED YES <br />TIME <br />PHONE FAX <br />NO REVIEW DATE <br />INITIALS <br />