Laserfiche WebLink
DATE RECEIVED _ ` EHD LOG NUMBER <br /> \ SAN JOAQUIN COUNTY <br /> \ • �`r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 ZI <br /> /468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.us/ehd <br /> /PUBLIC RECORDS / <br /> RELEASE APPLICATION <br /> APPLICANT: U�7 -�/✓.�.) /�12D BUSINEESSSIA�YENCY: 1' <br /> 1&45 �iVl.i"�Oi✓F�G7u7gG Z"y;L'Cj 7�, tF <br /> ADDRESS: /�✓/ /Sp. 1 S�G7/l .G. �%F' / dH-V/ E �`Y4� <br /> PHONE: D/ Y'OO`O /Lt Q �', ACSIIMILE:\1 1 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 busine s days from ate of application submittal) <br /> 4 <br /> El CHECK BOX TO EXPEDRE REQUEST-29. UEST P ESS D-I 1JSINESS DAYS C/ <br /> SIGNATURE OF APPLICANT J DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. sweet 16S city <br /> 2pee P�/ 23 130 2 El Unit <br /> . S1 <br /> a. sveel / S'eAPP P—QL2� QC?,s{ G i/CIC'! BP❑ U 2 _ <br /> s. slrce C{se //• _ G _ Unit 3 <br /> suee Unit 4 <br /> e. s4eet 7 ' /d7ZO // <br /> s. s4eet C' _ cAy Unit 5 <br /> 10. 5 <br /> city <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> >�/IUNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOVSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be 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 /> EHD 4"2-006 <br /> 6/ 003 <br />