Laserfiche WebLink
MAR_-08-2002 T16:27 • CAMBRIA • 1707 935 6649 P.01101 <br /> v� L•NU LVG NVMUUK <br /> SAN JOAQ IR NM NTAL UBLIC HEALTH SERVICES loot WEB R AVENUE,THI D) <br /> FLOOR <br /> 7STOCKTON CA 95202 <br /> (209) 468-3420 <br /> -3 1Y P(a LPALIC RECORDS RELEASE APPLICATION y <br /> APPLICANT Aµ a t �p I 13USINESSIAGENCY Ca-w4Yi?L. t1'C11�I1'I1Ti�-� <br /> ADORE55 7. <br /> IIt—cCA <br /> "f n Y t�IY�C. S'FY'CG� SOMI dYvii?t _ <br /> PHONE (70-1) 933-23(68 FACSIMILE 00 ) 93S- 70649 <br /> TENTATIVE'APPOINTMENT OATE 3 , TIME k 0 00 <br /> ( a py 7to n daysXEo <br /> eofnp 1cntionsubmi© CHECK BOX TO EXPEDITE RE O0FE� STP INp BUSINESS DAYS <br /> SIGNATURE OF APPLICANT \ r � —+ DATE B 0- <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> '1"100 Marelrx%cl, Coum,4. ck ss <br /> h4l W. •C In a-v,'ka- W S r- <br /> c at. <br /> O U�. G Er W 1444 35 a+• <br /> L:Incolh S 3Sa.y <br /> QnfgM 6+r t4 Ic sdG <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> rV4UNOERGROUND TANK(UST)CLEANUP SITE(LOP) E3 HOUSING ABATEMENT CISOLID WASTE FACILITY <br /> % OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PVMPERTRUCYtYARDICHEM TOILETS <br /> ❑ TATTOOIBODY FORCING Cl POOLISPA Cl 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 Tiles 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 now <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$87.00 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 DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> TOTAL P.01 <br />