Laserfiche WebLink
12/05/2002 12:10 2094671118 AGE STOCKTOH PAGE 01/01 <br /> DATE RECEIVED EHO LOG NUMBER <br /> SAN�AQUIN COUNTYPUBLIC HEALTH&RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> DEC O 5 ZOOZ STOCKTON 2 <br /> (209)468--34203420 <br /> ENVIRONMENT HFALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMf j. <br /> APPLICANT ` \\ r BUSINESS/AGENCY <br /> /�/'yf/fl,/iL'2d �C�adCnyll'011,�Qd l¢ <br /> ADDRESS 237 O `r'! D//t�/0 <br /> PHONE QD4 y f7_ 16616 FACSII�MIL/Et /y! 1 / <br /> TENTATIVE'APPOINTMENT GATE <br /> /1 �� 019 <�e5)* TIME M AM <br /> (Please give 7 to 10 business days from date of appliwtlon submlltal) Se SptPdo e <br /> )kREOBOX TO EXPEDITE REQU 7-SVi,Og FEE REQUEST PROCES O IN 3 BUSINESS DAYS 1 n 7}yanlc'�� <br /> SIGNATURE OF APPLICANT ( DATE <br /> FILE ADDRESS <br /> c <br /> r r r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®�N NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> HER CLEANUP SITE(NON•LOP) ❑ FOOD FACILITY ❑ SOLID WASTE 13VEHICLE <br /> DERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL ❑ DAIRY <br /> G <br /> =11111 <br /> R0WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 t0 (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 $78.00 deposit prior to review. <br /> 5, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE EI <br /> aM 90 44 01N900 f' f <br />