Laserfiche WebLink
DATE RECO rD SAN JOAQEHO LOG NUMBER <br /> . TJIN COUNTY <br /> ENVIRONMENTAL HEALTH AEPALZTMENT <br /> 304 E Weber Ave 3r6 Floor Stockton, CA 95205 Ro <br /> 3�F5(209)468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.camstelld <br /> EiVV1n1T,j11. ,d h!'_NjH PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT: <br /> //�� YI h� 1I�fin.LG C..-O SUSINESSIAGENgCY:�/�e f J w ,SdVV 't kik S'd C, <br /> ADDRESS: "107--ANS'41-�0.X <br /> PHONE: :>k _ 33-0 FACSIMILE: (ACI - 4_� <br /> TENTATIVE`APPOINTMENT DATE: ��1�Z(R�( Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT P===4E DATE <br /> DeDartment use Only <br /> FILE ADDRESS UNIT <br /> ,. streci 5'(53 t - S CII S r ❑ Unit I <br /> 5 <br /> a, Tel . M � . a <br /> 3. sl ., 6711 I— . city S 1 <br /> (. drool 16� LA . ab o unfit 2 <br /> s. sue D eI ✓il .° ff •' �C - alv g+s�Z�Gp+—i �L 1 Q(o nit 3 1 � <br /> 9. sirc0l N• aSIV�Gyg�l~ GN 97�-CIG,j]Sl-. �7`/C <br /> 7. sln:cl DIt �UU <br /> nit 4 <br /> e. street a <br /> s. seem ell p Unit 5 <br /> 10, street CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TA7700I800Y PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 $93.00 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 PATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 40-02-006 <br /> aon66a <br />