Laserfiche WebLink
SA, ,OAQUIN COUNTYPV13LIC HCALTI _RVICES r�u,ockuwka <br /> f �Lde ENVIRONMENTAL, HEALTH DIVISION <br /> W4 t:AUT WZZIERAVENUE,THIRD FLOOR <br /> A (2D4� y4N-p/3g STOCKTON CA 95202 <br /> (20$)408-J 2Q <br /> PUSUC RECORDS RELEASE APPLICATION <br /> A"uc"-r_.S4,g IVyAAl -5m' , aura�swAo>iNcr <br /> ADOREss <br /> PHONC FACAMU KD <br /> TENTATIVeAPPopirrie TDATi To" < <br /> (Pima era 7 to i0 baNnou tlw$Ir"date of apolloarlon albmtttmD <br /> CI=K VOX TO CfPCDITC RCQu=.SygAA0=. _RCQUCQT PROC"or IN l DUGWCOG DAYO <br /> 'SIGNATURE OF APPLICANT 9 b DATE <br /> SIDE WD BTAPP USR ONLY <br /> L;.rd - PROORAMMAMENra <br /> f <br /> �berr _ 3 a3 <br /> b O <br /> no <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> III VNVeROftOUND TANK(LIST]CLEANUP RITE(LOP) ❑ HOUSING ABATWENT O BOLL)WASTE FACIUTV <br /> O OTHER CLEANUP SITE(NOX.LOP) O POOR FACILITY ❑ SCUD WASTE VEHICLE <br /> W-UNDERGROUND TANK(MONITORING'REMOVAW C DOG KENNEL ❑ DAIRY <br /> ieHALARDOV3 WASTE 09KR,ATVR 0 CMICKW RANCN <br /> C D PM TREATMENT PLANT <br /> i7CRYn ItlJVa1T'r'!.j)r.+.C4RY . !7 erarrw�rarRl, D ■UUFCR TRUCt4YARPrGHr_at TUILL IS <br /> D TATTQOAWDY PEIRCU15 D POOUamA D LAND USE APPLICATION aRgii <br /> D MEDICAL WASTE FACILITY O PUBLIC WATrn AYSrPM D OTHER(PLEASE SPECIFY ASOVQ) <br /> 1. LISt up to ten addressca in the space above. Select the type(e) of tiles from the list above by checking <br /> the appropriate box("), At least one file type MUST be selected. Fax to (200)40"13E ar mall to HCI <br /> EEO ress Indicated above <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment fgr review will be confirmed <br /> approximately five bLminess days but no later than ten(10)days after recelpt Of application. The files <br /> will be hold for a maximum of live business mays for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EMD atatt may not be Immediatoly avalfable for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same Wndttion as relomd will 00 reorganized by EHD Etxff at the expense <br /> of the applicant. Future file reviews by the same sppiltant may require a $76.00 deposit prior to ravlaw, <br /> 'S. "TENTATIVE aPPointmefit dates must bo Confirmed with EHD staff, <br /> 6 Applications 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 /> C 70TPL P.01 <br /> ._.t�, <br />