Laserfiche WebLink
SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES LnuI.Ln„uMUER <br /> ENVIRONMENTAL HEALTH DIVIS10rj <br /> 304 FAST 3NEBER AVENUE,THM FLOOR � <br /> STOCKTON CA 45202 <br /> 4M)400-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Af+pLICgN7 qr-- N §y p �SUSINEGNIJ ENCr <br /> PHONE FAMkOLP, <br /> 'rF-NTATIVE`APPOKTMEKT QAC <br /> TIME <br /> {Pfeacr Diva t to 7q buolrwss eat':from¢fits of 3PPr+s�won sv>Smtitar <br /> ry <br /> CHECK COX TO EXPEDITE UQtXST-x78,aa FEE-REQUEST PROCLSSel>IN 3 BIUSINESs t3RY5 <br /> SIGNATURE OF APIPL.ICANT DATE <br /> ME ADIfO;;lrSS 91 ltd STAF tY3E ONLX <br /> t'RC{31tAM 64ErA€�{TS SLAKC►i O <br /> As`!` G H f <br /> _LA L5`_I <br /> -t2 w <br /> ! c. <br /> 17 rr�-:-r4 ' <br /> ENVIRONMENTAL HEALTH DIVISION FILF$ <br /> UKDERGROUND TANK(US))CL EAmuP$ fl <br /> ITE LLOf'? tlQliSlH4 Jti <br /> `9 OTHER CLEANUP SITE(MON-LOP) rl A)M FACIUN �� � SOLID WASTE FgCl!»n 1C <br /> UNDERGROW40 TANK(if 0Ntr0$tItgrRSM0VAL) 0 906 KENNEL 0 DAIRY WA83E VkFrICLE <br /> HAZUDOUS WASTE 09NtEMA-MR C3 CNICWN ItARCiO r l Pl(�7iiEA7>tsfrFlTf'IAN1 MA,9 2 9 2'- !G <br /> YIF-RrzQ TATTd Liao 1tIT7Fp FACII.(7Y d NHYMUN61VI. C3 0051PUl`TJWCKIYARojcHEm Tat .ETS <br /> � TAT7tlOfBpQY PEtliCillT(t CI Ptab119r+A ; <br /> 0 JACMCAL.wASTE FACiLrry CI LAND USE APPUCAT>¢N SMS { <br /> 13 PLMUC YJATT.9-SYSTEM R OTHER F2.I UIL SPEGIFY ABOVE J <br /> 1_ List up to telt addresses in tho duce Abov4. Sel rA the types)of T+ias tnosrl the list abov6 by chocking � <br /> U26 aPPropdatc box(e;), At lest Ana fits type MUST be"eeted. Fm tg Up}454. 138 or mail r`�LjQ <br /> 2. END Will notlfy th&applicant if any EHD tllaa axlat An ePlQintarCnt for 176view will be eonflrtned <br /> 8PPWXirriatrly fibs business days but no lalef than ten(10)dye o ter receipt of applicatiatL 'Cite filet' <br /> will be held for a mmdrrlurn dF five business days for MView, AppointmenlS should be scheduled <br /> tt{xord-ingly. I <br /> 3• A lite that is actively being worked oft by END staff MAY not be 4nmedi�ly avaiiatbi!far.pypaw. A naw 1 <br /> apP"r.RbOn MAY be submdtse when the Die is"aitabls. � <br /> 4, Any filo pet retUrned In the same torlditian as rgleasecd will bo reof2anlaed by EHI3 staff et the expense <br /> 5• <br /> attt►er<applicant. Future lite reviews by the-samb aWlicant may requirerequirea x78.00 deposit prior to review. I <br /> 'TENTATIVE 013014trnant dares must be confirmed w"EMD*t■ff. <br /> 6. Application*received atl`t'er 3:04 Pzn wilt be PCOC999eri the next buain.ss day_ <br /> CONFIRMED APPOINTMENT DATE , _- 'nME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NQ NEVIEV1l DA7`E <br /> TOTAL P.02 j <br /> I <br />