Laserfiche WebLink
DATE RECG'IVED EHD LOG NUMBER <br /> SAN JoAQvzN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`a Floor Stockton, CA 95205 RIO <br /> C7005 (209) 468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.us/ehd 3 5PU13LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Yt h6t, PZ"L_ � BUSINESSIAGENCY:_d.i AILNd/w.j'�Mn -t lk-E�—:o. _ <br /> ADDRESS: 0102 �Na�.'1V�s•,7""hctQ i�a�n LV-06- RSL-`fO <br /> PHONE: s�iQ�` '3 T v FACSIMILE: 3 �� <br /> TENTATIVE"APPOINTMENT DATE: 14DLRS— Time: q'. 6� <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 DATE I D 1 0) <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. strml 5153 vVl $k • rat S t ❑ Unit 1 <br /> a, street IR an✓\ 9cl1h 5 <br /> 3. sums 5 1 cily S Unit 2 <br /> d. such I ODD l.vt - atr S l a t {c F /1 <br /> s. Ste 0 E . ✓I l aA N C}• aloZ(� Unit 3 I <br /> s. slrmT N• SfNGI2't,✓' n aN S'f'�C�t-'i'7n /-�91C e'L (PD <br /> z srccT cu Unit 4 <br /> C. STreN �� <br /> 9. ,, at ❑ Unit 5 <br /> t0. 51reet a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) Cl 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 ❑ MOTELIHOTEL ❑ PUMPER TRUCK(YARU/CHEM TOILETS <br /> ❑ TATTOOIBODY 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)464-0136 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 d5-03-0116 <br /> aanaoa <br />