Laserfiche WebLink
FROM : NOR Environmental PHONE NO. : 209 369 42280 <br /> Dec. 23 2002 12:25PM P4 <br /> cxu Suc xuNSFn <br /> w �, -,SAN Jv QUIN COUNTYPUBLIC HEALTH SERVICES <br /> � ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> DEC 2 3 2002 STOCKTON CA 95202 ` <br /> (209)4683420 <br /> RECORDS RELEASE APPLICATION <br /> I_h1il, � <br /> APPLICANT �l _ -� / BUSINESSIAGENCYDf4 <br /> ADDRESS 7-z- 5-4)t" Li'l. ( C4 J -6 Z_ ") <br /> PHONE_ FACSIMILE lZ!2 »'3 =q'7 e <br /> TT // <br /> TENTATIVE'APPOIrtrMENT DATE 34A to, 2D6 TIME <br /> (Please give 71010 business days from date Of apPlicatlon submittal) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE—RE ESj PPROCESSED IN 3 BUSINESS DAYS � 3, <br /> SIGNATURE OF APPLICANT \/ DATE / Z3 <br /> f OFILE ADDRESS THIS SIDE EHD STAFF U32 ONLY <br /> PROGRAM ELEMENTS SEARCH ( A ` <br /> �� 7'2.5 S. U. �d• \�/ <br /> 3 S. obrz c � <br /> Ave_ Lo <br /> Ob <br /> 01 n <br /> 621 <br /> � • 16 IND <br /> WtOI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> IQ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILDY 0 SOLID WASTE VEHICLE <br /> Cf UNDERGROUND TANK(MONITORINGIREMOVAL) U DOG KENNEL O DAIRY <br /> ,Cf HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILrrY ❑ MOTEUIOTEL ❑ PUMPER TRUCK7YARD/CHEM TOILET$ <br /> C3 TATTOOIBODY PEIRCING ❑ POOI SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUEUC WATER SYSTEM !Q-OTHER(PLC-ASE S£SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of Tiles 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 some 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 /> REVIEWED YES NO REVIEW DATE <br />