Laserfiche WebLink
77 <br />v t �7 �`i= I' - ;�--'l` SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />�dOV 2 304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />`.�V\' Ii i lit\! i'vI C l� . I'l is r \i_i (209) 468-3420 <br />!T'ES PUBL21C RECORDS RELEASE APPLICATION <br />APPLCANT 1~ IJ 1 S ( 1 fO,0 8US1NF;$51AGENCY � , �lj ( f Ll IYIi-y�riY1L ,= tit <br />ADDRESS Z V)✓ ( JTZ0 I S <br />(i��—r <br />PHONE V FACSIMILE I 1 ��- 3249 <br />TATIVE' APPOINTMENT DATL' � C3' TIME <br />(Please ziva 7 LO 1,0 buwina.s days from dale of 7pplico0on submittal) <br />I <br />• <br />�' CHECKBOXTOEXPEDfTEFtEQ ST - $II7,00 FE — REQUEST PROCE�S�SIGNATURE OF APPLICANTI" ATE <br />' C16G HVVht�l� THIS SIDE EHD STAFF�USE ONLY <br />PROGRAM CLEMENTS SEARCH <br />3 <br />I <br />nn (-NNIIInIll IC <br />1 <br />1. <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />!1 <br />1 UNOERORQUN9 TANK tU5T) CLEANUP SITZ; fI.OP) ❑ HOUSING ABATEi41ENT XOLID WASTZ FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ F-000 FACILrTY O SOLID WASTE VEHICLE <br />�Q UNgERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKC TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY O MOTELIHOTEL O PUMPERTRUCKIYARDICHEM TOILETS <br />O TATTOO/BODY PEIRCING O POOIISPA — - ❑ LAND USE APPLICATION SITES <br />O WEIDICAL WA5TE FACILITY O PUBLIC WATER SYSTEM C OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses: in the space above. Select the type(s) of files from the fist above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fox -to (209) 464-0136 or mail to the <br />address 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 clays but no later than ten (10) days after receipt of application- The fifes <br />will be held for a maxim=um of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A fire that is actively brtin-q worxed on by EHD staff may not be immediately available for review. A now <br />i 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 />Ot the applicant. Future file reviews by the same applicant may require a $x7,00 deposit prior t_9_rev' e <br />5. 'TENTATIVE appointmerit dates must be confirmed with EHD staff, r <br />5. Applica�ons received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATEICONFIR14ED PHONE FAX INITIALS <br />IRZV., W L 0 YES NO --- <br />II Gv Iri oao7100 / REVIEW DATE <br />/ (���"� r CXR i `� /1 r) w 'I� j 001TOTAL P. O1 <br />I -d <br />8899-8t-9-9 T G dnouq l equ"LIO-I t nu3 apU dLe : t,0 60 Se now <br />0 <br />l� <br />