Laserfiche WebLink
ENVIRONMENTAL HEALTHPAGE 01"1m <br /> SAN <br /> 05/31/2002 15:06 46 1 <br /> " SANQUIN COUNTYPUBLIC HEALTH SER1*S <br /> ENVIRONMENTAL HEALTH DIVISION / <br /> ( / v 304 EAST WEBER AVENUE,THIRD FLOOR AIR <br /> YQ s STOCKTON CA 95202 R,✓ <br /> (209)468-3420 FAX C20)` -013 B <br /> ' PUBLIC RECORDS RELEASE APPLICATION <br /> P LICANT BUSINESS/IAGENCY J <br /> ADDRESS 1(� (' (707 ICG COOc r� C /'4 7SZI/l <br /> PHONE 7D�' - 433 /r? FACSIMILE los- �33'd`f9Z .. _ <br /> a (� -/Z-- b Z TIME /, dTJ'" <br /> NTATIVE'APPOINTMENT DATE appliQ an submlltal) _ <br /> (Please give T t 10 usl els 2002 <br /> CHECK BOX TO EXPEDITE REOUE -989.0 U ST DCICE INESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> v/ S,c ' - <br /> z A-V-- - A^ <br /> N. a;n rR wbr C A 1 <br /> Z el A' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY El SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(MON-LOP) 0 DAIRY <br /> 13 UNDERGROUND TANK(MONR0 FORINGIREMOVALI OO KENNEL 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 12'HAZARDOUS WASTE GENERATOR 0 CHICKEN <br /> ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TIERED PERMITTED FACILITY ❑ POTELMOTELOUSFA 0 LAND USE APPLICATION SITES <br /> Cl TATTODIBODY PEIRCING 0 PUBLIC WATER SYSTEM D OTHER(PLEASE SPECIFY ABOVE) <br /> 0 MEDICAL WASTE FACIDTV ' <br /> he <br /> (s)of files from the <br /> above <br /> ist <br /> 1• props ate box(s). II <br /> List UP to ton addresses checki <br /> At least one file type MUS' selected r Fax to (20 1 4164-013 8 orbmail to the <br /> thea <br /> address ind'caled above. <br /> 2, EHD Will notify—a the apPllcant if any EHD}Iles exist An ap;ink ent}er review will hThe files <br /> appruxlmatelyfive business days but no later than len(10 days after receipt of application. <br /> will behold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3, A icor that Is actively being worked on by EHD staff may not be immediately available for review. new <br /> application may be submitted when the 1110 is available. EHD at <br /> 4 oAny f hetapplicant. Future file sreviews by the samame condition as e applicant ltmay require a$89The reorganized y 0 deposit t prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed Pith EHD staff. <br /> 6 Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. <br /> TIME <br /> PHONE FAX INITIALS <br /> DATE CONFIRMED <br /> YES NO REVIEW DATE <br /> REVIEWED 7671 oB10 o nest/ <br /> • ^�— Poatdf Fax Note <br /> To r Fom <br /> (AAxv Pr11��td1� $ T 20 <br /> Proms r P"'a/ <br /> Fax$ ZoS 9:33 D ( 7 Z..Fay oq-a . 1(OLl -0i� <br /> eSi :LO ZO L0 unC <br /> l -d . <br />