Laserfiche WebLink
05/31/2002 15:06 4640130 ENVIRDNMENTAL HEALTH PAGE 01 <br /> \ _ ow foo xaMew <br /> �I SAN JUIN COUNTYPUBLIC HEALTH SERVOP X <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 1 <br /> STOCKTON CA 95202 <br /> (209)468 FAX (zoq)Q 64-013 B. <br /> ®` FAX <br /> RECORDS RELEASE APPLICATION ( ' <br /> �"*;PPPUCANT {�/I S /h�Lr7v%rdHAwYk SCr L i J t r v,(�Q <br /> �j � BUSINESS/AGENCY ® all <br /> n�v ' ADDRESS f - � ,107/ II//0(, �/LOO�rC r4 �.�Z1/1 y� <br /> PHONE P D4- 43 3 • 6;Ir? /FACSIMILE los— r33.Oy 9 z <br /> NTATIVE'APPOINTMENT DATE ��%,� TIME <br /> (Phase give T I usl hs appliti len submittal) _ <br /> P002 <br /> CNECK BOx TO EXPEDITE REOUE •;SS.O ST t7CE �3 E (NESS DAYS -7 <br /> SIGNATURE OF APPLICANT DATE ` / —0 Z <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> N/ 1 sc,� <br /> Z P �� A^ r N <br /> si . s <br /> IMIM 11 <br /> ni <br /> M/ JO* <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> }INDERGROUND TANK(UST)CLEANUP SITE ILOP) C3 HOUSING ADATEM ENT ❑ SOLID WASTE FACILITY <br /> ®'OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑}�NOERGROUND TANK(MONITORINOIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> / HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PUNT <br /> ❑ TIERED PERMITTED FACILITY O MOTEIMOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOLSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 7• List up to len addresses in the space above. Select the type(5)of flies 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 indicatedabove. <br /> 2. EHD will notify the applicant it any EHD flies exist An appointment for review will be confirmed <br /> approximately five business days but no later than len(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 fila 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 /> REVIEWED YES NO REVIEW DATE <br /> Post4f Fax Note 7671 Data ouef� <br /> I Flom .r• / �7 <br /> Paoe1l MOM I�k 2 <br /> Faa1 z, s 333 OY9 2.. F"Isoe . 'tco�I <br /> �— f ,d eST :LO ZO LO un[, <br />