Laserfiche WebLink
OEC. 2. 2003 2:54PM CCEARTH TECH N0. 1619 P. 1 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBt <br /> ENVIRONIMENTAL HEALTH DEPARTMENT <br /> r <br /> : ,-ri : �, <br /> 304 E Weber Ave 3'Floor Stockton, CA 95205 -� � <br /> �. 1-1EAL.111 <br /> q( W'W.W.Cc).San-joaquin,ca.us/chd <br /> 468-342'0 Fax: (209)464-0138 Web: w .Cota j <br /> .Saoaquin,ca.us/chd r - I'1 IU <br /> P'YTflRRT C RECORDS RELEASE APPLICATION 03 DEC -2 PM 3: 42 <br /> APPr .rcANr: F c� � , BUSINESS/AGENCY: K—) 7-)�n 1 ' T <br /> A4DRE5S; b a ��— w ► cc.� <br /> PHONSr �Toc iC-� <br /> f �`! c� f O l 1C —� 0 S <br /> --� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: f ' --"— Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED W 3 allSrNFSS YS <br /> SIGNATURE OF APPLICANT 6W' <br /> t� DATE' . 03 <br /> LIFO — nn r,^ <br /> DePartMent Use Only <br /> FtIE ADDRESS UNIT <br /> p <br /> ° 2 ` G s ❑ Unit 1 <br /> 0Af Isv 3- Street (t <br /> 0 ,. saner Ef /JI,y"'.-C 10,1 Tom'- 6 I n;0 <br /> D 5. Street <br /> 6. Street 1p 7 <br /> aly Unl <br /> 7 Stl /`'!ll I/ CRY <br /> a. Sweet �� S r <br /> G f nit 4 <br /> 9. Sweet a • a <br /> a <br /> to. SVW ❑ Unit 5 <br /> 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY SOLID WASTSOUD E VEHILE <br /> UNDERGROUND TANK(MONITORiNG1REMOVAL) ❑ DOG KENNEL d DAIRY WASTE VEHICCLE <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEI. 13 LAND USE APPLICATION❑ PUMPER TRUCK11'ARDlCHIASEM <br /> M TOILETS <br /> TATTOO/BODY PIERCING ❑ POOUSPA <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1• Gist up to ten addresses In the space above. Select the type(s)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 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. Anew <br /> application may be submitted when the file is available. <br /> 4. Any File not returned in the same condltlon 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$93.00 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 /> RATE CONFIPMED PHONE - FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Elio 48-020a6 <br /> darlaaa 2. 37u� <br />