Laserfiche WebLink
DATE RECEIVED EHD I,OG NUMBER <br />SAN 4WQLLLN COUNTYPUBLIC HEALTF'WRVICES <br />°7�� , i• -,� ' ONMENTAL HEALTH DIVIS"I 9 <br />I ' 4 ST WEBER AVENUE, THIRD FLOOR <br />AN 2 5 2002 �'f STOCKTON CA 95202 <br />(209) 468-3420 <br />ENVRONMENl tJEAJH PUBLIC RECORDS RELEASE APPLICATI " 111' <br />APPLICANT ' WNA& <br />.L! BUSINESSIAGENCY, <br />ADDRESS 1 <br />--rrO ) � u-' Ck <br />PHONE �"C - l4gta 1 5 aII FA(y/��)CSIMILE � <br />TENTATIVE' APPOINTMENT DATE wow ' ( 1:30 <br />(Please give 7 to 10 business days from c <br />1 Z <br />t2/1CHECK BOX TO EXPEDITE REQUEST - $89.UDFEE /REQUE$TPROC,E1 <br />2 TIME ) J-" W <br />of application submittal) <br />IN 3 BUSINESS DAYS <br />FIT-A9Z <br />V (\ <br />I a r <br />1 <_j 1 <br />i <br />THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL <br />HEALTH DIVISION <br />FILES <br />J/ <br />Ga XCTANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT - <br />❑ <br />SOLID WASTE FACILITY <br />UZ CLEANUP SITE (NON -LOP) <br />❑ <br />FOOD FACILITY <br />❑ <br />SOLID WASTE VEHICLE <br />,,OTHER <br />TANK (MONITORINGIREMOVAL) <br />❑ <br />DOG KENNEL <br />'h►�,�a'—�:�,... ._ _ u _ <br />, <br />�f;Jfi111111fi1lPRIN <br />❑ <br />CHICKEN RANCH <br />llrlliT7r- n <br />'0111 <br />PKG TREATMENT PLANT <br />LQ/TIERED PERMITTED FACILITY <br />❑ <br />MOTELIHOTEL <br />❑ <br />PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOIBODY PEIRCING <br />❑ <br />POOLISPA <br />❑ <br />LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ <br />PUBLIC WATER SYSTEM <br />1 <_j 1 <br />ENVIRONMENTAL <br />HEALTH DIVISION <br />FILES <br />J/ <br />Ga XCTANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT - <br />❑ <br />SOLID WASTE FACILITY <br />UZ CLEANUP SITE (NON -LOP) <br />❑ <br />FOOD FACILITY <br />❑ <br />SOLID WASTE VEHICLE <br />,,OTHER <br />TANK (MONITORINGIREMOVAL) <br />❑ <br />DOG KENNEL <br />❑ <br />DAIRY <br />�NDERGROUND <br />jjIIAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />❑ <br />PKG TREATMENT PLANT <br />LQ/TIERED PERMITTED FACILITY <br />❑ <br />MOTELIHOTEL <br />❑ <br />PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOIBODY PEIRCING <br />❑ <br />POOLISPA <br />❑ <br />LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ <br />PUBLIC WATER SYSTEM <br />❑ <br />OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the space 0bove. 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 $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 <br />DATE CONFIRMED <br />REVIEWED <br />YES NO <br />TIME <br />PHONE FAX INITIALS <br />REVIEW DATE <br />