Laserfiche WebLink
- AUG. L(, 1U04 4:4UYM CUNUUK EAKIH TECH N0, 6355 P. 1 <br /> DATE RECEIVED � 'ft*0 <br /> (��p (� �' SAN JOAQM COUNTY EHD LOG NUMBER <br /> REv t'=U v E V ENSrIRONWNTAL HEALTH DEPARTNXENI• <br /> 304 E Weber Ave 3d FIoor Stockton, CA 95205 <br /> AUG 2 7 Z009)468-3420 Fax: (209)464-0138 Web:www,co.san joaquin,ca.us/ehd I <br /> MENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> EgMIT Ir-fca� �-�DUSINESWAGENCY. <br /> t�OHJ;z.4ADDRESS: 166 ✓a mtit[ 455 Ti (nc(t�'o�, !�/ <br /> PHONE: 2.0 9 — 2—$4 �6-'2tq FACSIMILE: 2. j - .S-)-0538 <br /> TENTATIVE*APPOINTMENT DATE: /0 5Qdta.,•n�rGl' 2404 'rime: S_ 30 QM <br /> (Please allow 10 business days Dom date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$83.00 FEE—RE EST PR ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `-` LJ DATE Z o O <br /> D4arneA use only <br /> KILE ADDRESS UNIT <br /> ,. soev d n114 Cox S+ac(e <br /> ✓ z sues d S G F-1 Unit 1 <br /> o. 5vaa 2y u 9- 7—to <br /> ti F1 I Init 2 <br /> ✓,�✓ s. suan Ica 5 (764Ma sueee I v a <br /> L Unit 3 <br /> T. s�r $ 2- d. ,s E5 At <br /> A s,.� 1 14 , 5 eUnit4 <br /> Q. sem, 4%4- <br /> 1a Soso q� EJUnit5 <br /> tti �^ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE -9 2 aAr <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOUD WASTE FACILITY <br /> CLEANUP OTHER SITE(NON-LOP) O FOOD FACILITY SOLID WASTE VEHICLE <br /> .'UNDERGROUND TANK(MONfTORINGIREMOVAL) ❑ 1100 KENNEL DAIRY <br /> T�HAZARDOUS WASTE GENERATOR O CHICKEN RANCH q PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITYTATTO MOTELIHOTEL ❑ PUMPER TRUCKf(ARD/CHEM TOILETS <br /> ❑ MEDICAL/BODY <br /> WAPIESTE <br /> 13 POOUSPA-- - - ---- - --0_LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> 7. 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. END 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$93.00 deposk prior to review. <br /> S. *7ENTATNE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> Eb<p pE�oIt1T111JE7*t3klxE;. .. ; <br /> .{'w .:filldE •1 T <br /> a 1319 Mua.i50YI U5`r IS ct, 0A. ed8. <br />