Laserfiche WebLink
W, <br />O41 <br />SAN .b QUIN COUNTYPUBLIC HEALTH SL-t-AMES <br />d.� ENVIRONMENTAL HEALTH DIVISION Qw <br />• 304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(200) 468.34211 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSIN <br />ADDRESS XLJOfl .L?ESI VUUTiI VSur t .1L11Ir,- �rrrus <br />Pk -'.DNF q16 — -7a--3--! 4,'yC FACSIMILE Il ' —t 7�5 W, <br />/o <br />TEN 7A fiVE`APPOINTNIr NTDATO I rt.4Cti1' Q/ of TIME /Q• 60 • <br />(P leas n give 7 le 1P_ /Ga5I ndssT-.,J trwn date of apyl ieation s=mitW i) <br />J C.4/ <br />CHECK BOX TO E%YEOI7E fiGQJEST - 5±:: �1G , E5- RE4li.E.,S�TP�O\CE`D/N 3 BUSINE$$ DA :'S i <br />SIGNATURE OF AfiPLICANT _ _/1 .C'L.Z/_d7. LJQ�IL�_ GATE <br />ENVIRONMENTAL II[ALTH DIVISION FILES <br />riDERliROU7QO TANK (UST) CLEANUP Sol p.,.)?) <br />"—' HCUSiNG ABATEMENT <br />.".+ SOLIn WASTE PACWTY M py 17 <br />OTHHR CLEA.,Up srrh (NON -LOP) <br />G FOOD FACILITY <br />❑ SOLID WASTE VEHICIF <br />,.UNDERGROUND TANK (M ONRORINGIREM OVAL) <br />❑� DOG KENNEL <br />13oAIRY <br />HAZARDOUS WASTE GENERATOR <br />= CHICKEN RAt:CH <br />❑ PKG TREATMENT PLA":T <br />O TIERED PERMRYED rAGILITI' <br />❑ MOTEL"NOTEL <br />a PUMPER TR-JCWYARDICHEM TOILETS <br />C TAI ' C09ODY P=IRCLSC <br />0 POOIJSPA <br />Cl LAND USE APPUCATION ffiTES <br />M MIEOICA. WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM. <br />❑ OTNER(PLEASE sPEC)rY ADOVI <br />2001 O <br />1. List up to ten addresses )n the space shove. Select the type(s) of tiles 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 wilt notify the applicant if any EHD tiles exist An appointment for review will be confirmed <br />approximately five business days but no later than ten (1U) 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 />accord;ngly. <br />3. A file that is actively being worked on by EHD staff may not be 4nmcdiately available for review. Anew <br />application may be submitted when the file is available. <br />A. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br />of the applicant. Future fife reviews by the same applicant may require a 357.00 deposit prior to review, <br />5. "TENTATIVE appointment dates must be confirmed with EHD staft. <br />S. Applications received after 3,70 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED <br />TIME <br />PHONE FAX <br />NO REVIEW DATE <br />INITIALS <br />TOTAL P.01 <br />