Laserfiche WebLink
� I i , '� CIII! SOC IIUMIILII <br />SAN J04., UIN COUNTYPUBLIC HEALTH -- <br />ENVIRONMENTAL HEALTH DIVISION <br />FEB 2 5 2003 v 304 EAST WEBER AVENUE, THIRD FLOOR 170 <br />STOCKTON CA 95202 I <br />FNVIRUNMENT HEALTH (209) 468-3420 ' <br />PFRnA117SER••.fIGES 'PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT a�DEXAiN l7la i• -P N i DUSINL-SSIAGENCY A(� �- I t%' <br />ADDRESS <I -to 'I q L if IL Sr• •'�)Tlf Z - CA' �1ti510 <br />PHONE FACSIMILE :? 4 <br />TENTATIVE' APPOINTMENT DATE TIME <br />(Please give 7 to 10 business days from data of application submittal) <br />CHECK DO)f TO EXPEDITE REQUEST - $09.00 FpL-C- —REQUEST PROCESSED IN J BUSINESS DAYS <br />SIGNATURE OF APPLICANT _-Dr-G-�' GY c� -— DATE <br />FILE ADDRESS <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />i <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />. ❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ <br />SOLID WASTE VEHICLE <br />-A UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />O <br />DAIRY' <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ <br />PKG TREATMENT PLANT <br />C1 TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ <br />PUMPER TRUCKIYAnOIC11EM YOILETS <br />❑ TATTOOIDODY PEIRCING <br />❑ POOLISPA <br />❑ <br />LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY ., <br />O PUBLIC WATER SYSTEM <br />t] <br />OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ton addresses In the space above. Select tho typo(s) of files from the list above by checking <br />the appropriate box(es). At least one filo 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 ton (10) days after receipt of application. The files <br />will be hold for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A file lhat.1s, actively bhing worked on by EHD staff may not be immediately available for review. A now <br />application may bo:submitted when the file Is available. <br />4. Any file not returned iR the same condition as reloasbd will be reorganized by EHD staff at the expense <br />of the applicant. Future fila reviews by the same applicant may require a $89.00 deposit prior to review. <br />5. •TENTATIVE appointment dates must be confirmed with EHD staff. <br />G. I Applications received after 3.00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE. <br />DATE CONFIRMED <br />REVIEWED YES NO <br />TIME <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />