Laserfiche WebLink
2.94671 AGE STCI ALT PAGE 02 <br /> SAN JUIN COUNTYPUBLIC HEALTH 5ICES <br /> ENVIRONMENTAL HEALTH DIVISIO� <br /> OCT 1 8 2000 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> NVIRONMENT HEALTH (209) 468-3420APPLICATION PUBLIC RECORDS RELEASE <br /> ��,��I�FRVIrFS /! <br /> APPLICANT 1d BUS,NESS,AGEN.Y aC/ aA,[..eJ 6QCr1l1����1i[�� <br /> ADDRESS yDO S J• W SD CZ -7 l>� sansJ- <br /> PHONE QQ Z114 2-10OIh <br /> //ccFAC1�SIMILE <br /> TENTATIVE'APPOINTMENT DATE_ Q A -2-5 TIME <br /> (Pic"e give 7 to 10 business days from date of application submitral) <br /> 0 CHECK BOX TO EXPEDITE REQUEST•S78.a EE(�-RE FST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ls4 ,. — DATE <br /> FILE ADDRESS - <br /> ss•a g <br /> - -A -- <br /> I. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> K OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> X HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH B PKG TREATMENT PLANT <br /> ❑ MOTEUHOTEL ❑ PUMPER TRIICKIYARD/CHEN 70ILETS <br /> ❑ TIERED TATTOOMODYPERMIFO FACILITY n LAND USEAPPLICATION SITES <br /> ❑ MEDICAL WAS FORCING ❑ PUBLICW <br /> ❑ MEDICAL WASTE FACILITY Cl PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 9. 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 mpil to the <br /> address indicated above. <br /> 2_ EHD will notify the applicant if any EH}D 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. EHD staff at the expense <br /> •4, Any file not returned in the same condition as released will be reorganized by P <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 /> 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 /> EH 00 14 Oro <br />