Laserfiche WebLink
SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 9� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR / <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT.Tt9hl't ey's '*- BUS INCSSIAGENCY CQL <br /> ADDRESS AAOI-fB/d�x.l 78�/ <br /> J/� �5 <br /> r'HONE l'-J2'7T _ FACSIMILE <br /> TENTATIVE-APPOINTMENTDATC r<fr ✓I" 7.00) TIME <br /> (Please give 7 to 10 business;days from date of application Submittal) <br /> ` CHECK HOK TO,EXPi_DITE REQUEST-$97.03 F E-RF 5T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT PATE <br /> f1L IF ADDRESS YH15 510E EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SLAKCH <br /> 4 Jtii ec K <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILL'S <br /> rtf UNDERGROUND TANK tV54)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT O SOLID WA5TC FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VCfI1CLL <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOC;KENNEL O DAIRY <br /> ❑ HAZARDOUS WA57C GENERATOR d CHICKEN RANCH ❑ PKG YREATMENT PLANT <br /> ❑ TICR.CD PERMIZ'r D FACILITYAOTIHOTEL ❑ PUMPTkUGKlYARD(GHEM TOILETS <br /> ❑ TATTODISOPY P�RGING Cl© ELUR❑ POOL/SPA - ❑ LAND USE APPLICATION SITES <br /> Q MEDICAL WAG-re FACILITY ❑ PUBLIC WATEK SYSTEM o OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up tQ ten addresses in the space above. Select the type(s) of files from the list above by chocking <br /> the appl'opriate box(es). At least one file type MUST be selected. Fax to (709) 46"1 or mail to the <br /> address indicated above- <br /> 2. EHD will notify the applicant if any EHl)files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ton (10)days after receipt of application. The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3- A filo that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitteq when the file is av4ilable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EMD staff at the expense <br /> of the applicant. Future file reviews by the same applir.Ant may require a$87.00 deposit prior to raview. <br /> 5. •TENTATJVE appointment datas 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 /> i DATE CONFIRN1ED PHONE FAX INITIALS <br /> J REVIEWED YES NO REVIEW PATE <br /> K w 14 M#71" <br />