Laserfiche WebLink
07/08/2002 MON 12;50 FAX 916 5654356 2001/001 <br /> utr ver iooc in:ve 014JOAQUIN COUNTYPUBLIIALTH SERVICES ` PAGE 91 <br /> 4MO I,Oe NUMBgy <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 01 304 EAST WEBER AVENUE,THIRD FLOOR I ,/ <br /> STOCI(TON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIOI <br /> APPLK:AN*I_(_/.T,{�./ Er„ uWj BUStNES81AGENCY.cS�ytacJ r✓t�•o�.���,T-.,.,v . <br /> I - <br /> aoDREss __2e. <br /> PHONE <j2_- LEmoi_ GAC3lMILE ��/Li'.J�•5-4.25(i.. . <br /> - . rl-TENTATIVE*APPOINTMENT DATE TIME • <br /> C-� (Pieria give T t 1 sapPg aubmlttai) <br /> I <br /> CHECK BOX 70 EXPEDITE REQUEST- ,W F - QUEST OCES 11] %NES$DAYS <br /> SIGN&','URE OF APPLICANT DATE6la2la <br /> CI _ <br /> PILE ADDRESS THis s%oE EHD s7AFF use ONLr <br /> PROGRAM�ELEhIZNTS SEARCH <br /> D J Sz <br /> r z <br /> z <br /> w <br /> z" <br /> D / <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Id UNDERGROUND TANK(U"CLEANUP SITE(LOP) o HOUSING ABATEMENT D SOLD WASTE FACILITY <br /> ❑ OTHER CLEANUP srrE(HON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIRCMOVAL) O DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR D CHICKEN RANCH . ❑ PKG TREATMENT PLANT <br /> d TIFRCO PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YAROICHEM TOILETS <br /> ❑ TATTOOJnQDYPE1RCING D POOVSPA in LANDUSEAPPLICAMONsITES • <br /> ❑ MEDICAL WASTE FACIL]Mr ❑ PUBLIC WATER SYSTEM o OTHER TLEASE 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 appropriateebox(es), At least one file typo MUST be selected. Fax to(2091 464-0138 or mall to the <br /> address indicated above. <br /> z. 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 rocelpt 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$89,(10 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 INfT1ALS <br /> REVIEWED YES NO �. ,_ REVMV nILT.E-... ..— <br /> •n wnnr <br /> Post-'e Fax Note 7671 Dn°B7 r2. Nip" <br /> io From <br /> COJDAPL "�GO E �� ' <br /> Ph.• r1wlp eLe� 4 k- <br />