Laserfiche WebLink
v SAN JOF )IN COUNTYPU13LIC HEALTH SE /ICES 1 E111140G NUMOEN <br /> W EIM/IRONMENTAL HEALTH DIVISION °'�� <br /> O 1,n 304 EAST WEBER AVENUE,THIRD FLOOR <br /> h;. rIE QI-)f I STOCKTON CA 95202 ,j2 <br /> (209) 468-3420 <br /> 02 OCT 16PR FNC RECORDS RELEASE APPLICATION �ivvihol�IvlElaT HEALTH <br /> n IE tl <br /> APPLICANT Ncl�j Q4 5 BUSINESSIAGENCY 14Wdl, d4" ��. 5 Cf.�JJj LIP <br /> ADDRESS <br /> PHONE( Z0/) C1-7 q^3F_33 // FACSIMILE //,,�� <br /> TENTATIVE'APPOINTMENT DATE la% TIME �� All <br /> (Please give 7 to 10 busin days date o pplication submittal) <br /> CHECK BOX TO EXPEDITE REQUE�O�FE� l CSS IN J BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 0 <br /> OS" <br /> N — %G6 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �}iNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT. ❑ SOLID WASTE FACILITY <br /> tl HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> S UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIDODYPEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton 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 tan (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 $89.00 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 /> REVIEWEDYES_ NO REVIEW DATE " <br /> •II 111111!r �• <br /> .V O <br />