Laserfiche WebLink
SAN ?AQUIN COUNTYPUBLIC HEALTIARVICES 00/072 <br />R` ENVIRONMENTAL HEALTH DIVISION 3 <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT 1..1)I BUSINESSIAGENCY -TII,\�-_ t -V C-jLLY 6 <br />ADDRESS 10, F31i 1`. `l <ta�' -5Z'Ae kT'"b GtQ �S'I9 <br />PHONE (3,021 CT$ I - Q') n (1 FACSIMILE ZD - a6) rat all -a <br />TENTATIVE" APPOINTMENT DATE TIME I t r <br />-2C 40 <br />(Please give 7 to 10 business days from date of application submittal)171 O <br />CHECK BOX TO EXPEDITE REQUEST - $78.00 FEE -REQUEST PROCESSED IN J BUSINESS DAYS O <br />SIGNATURE OF APPLICANT �rn �1e6(�,, DATE 3113101 O <br />.� .'• ani 1, <br />��,I]KA1 1 tfilryo= I am <br />MIM <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT <br />❑ <br />SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ <br />FOOD FACILITY <br />❑ <br />SOLID WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ <br />DOG KENNEL <br />❑ <br />DAIRY <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />❑ <br />PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ <br />MOTELIHOTEL <br />❑ <br />PUMPER TRUCK/YARD/CHEM 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 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 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 $78.00 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 />F <br />D APPOINTMENT DATE <br />TIME <br />PHONE FAX <br />INITIALS <br />