Laserfiche WebLink
DATE RECEIVED <br /> V SAN JQAQUIN COUNTYPUBLIC HEALTH SERVICUP <br /> ONVIRONMENTAL HEALTH DIVI&N <br /> 304 EAST WEBER AVENUE,THIRD FLOOR L <br /> STOCKTON CA 95202J i; <br /> (209) 468-3420 ; t l r :, a 4 l i�• ' <br /> PUBLIC RECORDS RELEASE APPLICA <br /> APPLICANT 'f �aG 4 f ! BUSINESSIAGENCY <br /> ADDRESS /8'30 V-- n,", SJt, <br /> PHON n d5�' rl�t c,4 7�6— FACSIMILE <br /> IF-2� 02 fi�l,�, 111vr G <br /> TENTATI TMENT DATE TIME <br /> Please give 7 to 10 ess da rom d f applicati submittal) <br /> CHECK BOX TO EXPEDITE RE SN- B!' . 0 RUES PROSES 43 13 IN> SS DAYS <br /> SIGNATURE OF APPLICANT DATE V `t <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ✓ Zas �4a w,Wf.„orc S� <br /> ap feces GA <br /> 1 20 <br /> P _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> • UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT IP SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY i SOLID WASTE VEHICLE <br /> A OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL I3 DAIRY <br /> Ig UNDERGROUND TANK(MO 0 CHICKEN RANCH It] PKG TREATMENT PLANT <br /> N HAZARDOUS WASTE GENERATOR ❑ MOTEL/HOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> 14 TIERED PERMITTED FACILITY p POOLISPA ❑ LAND USE APPLICATION SITES <br /> 13 TATTOOIBODY PEIRCING IP PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> OR MEDICAL WASTE FACILITY <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 209 464-0138 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 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 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 <br /> e ce same onfirmed applicant <br /> may require a $89.00 deposit prior to review <br /> 5. 'TENTATIVE appointment dates must b <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> F <br /> FIRMEDAPPOINTMENT DATE TIME <br /> OM CONFIRMED <br /> PHONE FAX INITIALS <br /> ED <br /> REVIEWED YES NO REVIEW DATE <br /> t+ 7_5„. <br />