Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
L r SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES <br /> 1 VIRONMiwNTAL HEALTH DIViSlC:� <br /> NW64 EAST WF-BER AVENUE,THIRD FLOOR <br /> STOCKCTON CA M02 <br /> (209)468-3420 � I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPL)GANTC BUSINESWAGENCY <br /> ADDRESS A9�t —f��,�7r+� �fl � <br /> PHORE FACSIMfLEfRd`7•, � XL• <br />` TrzWrATIVE"APPOINTMENT nATE caticn II <br /> (Please give 7 t0 10 bu54W"dgy6 from date of applisubmttwl) <br /> 0 CHECK 80XTQ EXPEDITE REQuESr-578.00 FEE-REQUEST'PROCESSED IN 3 6USINESS-VANS <br /> f I` <br /> SIGNATURE OF APPUGANT i DATE <br /> 4 � .p I <br /> FILE ADDRESS I I <br /> � l <br /> :I <br /> • "s <br /> Ii <br /> .k <br /> ENVIRONMENTAL HEALTH DIVI&ON FILES <br /> XUNDERGROUND TANK(Usr)CLEANUP SqE(LOP) ❑ HOUSING ADATEMIgNT i 01 SQtM WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NOD44-OP) ❑ FOOD FAGILQ'Y Cl SOLID WASTE VEHICLE <br /> XuNDERGROUND TANK(MONITOWNG)REMOVAL) D DOG KENNEL la 1, DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 13 CHICKEM RA)VCH DI PK6 TREAYMEW PLANT <br /> M TIERED FgRefRTED FACUM'Y 13 1ACTELIHOTeL Cli PUMPER TRUC1VYAR=HEJA TOfLETS <br /> 0 TATTOO(BODY PEiRICING 0 POOVSPA 0I LAND USE APPLICATION SITES <br /> 0 mLDICAL vvASTE FAcluTY ❑ PUBLIC WATER 51fST M ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> .i <br /> I t. List up to ten addresses in the space above. Select the type(s)of flies by checking <br /> the appropriate box(es). At least one file type MUST be seleat - Fax 38 maij to the <br /> addraass IHdicated abbY9_ I <br /> EHD wilt notify the alaplicanx if any EHE)files exist_ An appoidtment1or review will be confirmed <br /> approximately five business days but no tater than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business daly5 for review. Appair tma:nts should be scheduled <br /> aroordingly. <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 $Mailable. 'I <br /> 4. Any file not returned in the same condition as released will be rearganiYed by FIND staff at the expense <br /> of the appliaramt. Future file raayiews by the same applicant may require a$78.00 deposit prior to review_ <br /> S. 'rEWATIYEointment dates must be Gorltlrmed with EHD jstaff. <br /> �p I <br /> 6. Applications received after 3:00 pm will be processed the next Lousiness day. <br /> CONFIRMED APPOINTMENT DATE= TIME <br /> I <br /> DATE CONFIRMED PHONE FAX INITIAL <br /> .f <br /> REVIEWED YES NO REVIEW BATE <br /> E!f oo ++ Ol/tSTOQ � <br /> TIUAL P.02 <br /> I <br />