Laserfiche WebLink
UAI�A �I.CAVty <br /> SAN JOAQUIN COUNTY <br /> _!) <br /> ENV,_,) M <br /> NENTAL HEALTH DEPARTMv T <br /> DEC 0 4 003 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> �L0 ) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ,uif <br /> >,V(CFS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KIASfY /r.'F TFNsflu BUSINESS/AGENCY: E,y6EG /,U('. <br /> ADDRESS: 2 D n0 /0 7*/fes-PY 130. 5U(71, 3., ("/j <br /> PHONE: 209 • 533 15- 06(0 • FACSIMILE: BU`s 6t's 7!T <br /> TENTATIVE`APPOINTMENT DATE: 4 S(?h /tf'f SE Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> /SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> N (ttt 1. Street 06 - S7 qtr 7F 20 city M VC, Unit <br /> 2. Street O F Roq-re 126 oty UPC, <br /> L a�n "7 <br /> ry�Yt� J. Street L� � Ci NAo Unit 2 <br /> ROADS � o Ro A <br /> r7J <br /> 1,0 p 15. Street 4161 tiE L city / <br /> 40 Street 601 f City — <br /> Street Of �( CII Unl <br /> Street 7)01 tV CRY V <br /> 9. street OR, Unit 5 <br /> 10. street O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> U' NDERGROUND TANK(UST)CLEANUP SITE(LOP)-O'HOUSING ABATEMENT OLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) COD FACILITY i '�S LID WASTE VEHICLE <br /> _ l° UNDERGROUND TANK(MONITORING/REMOVAL) M OG KENNEL fdD RY <br /> Ny <br /> HAZARDOUS WASTE GENERATOR HICKEN RANCH PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY SPI MOTEL/HOTEL �- UMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ ATTOO/BODY PIERCING 2'fOOL/SPA X LAND USE APPLICATION SITES <br /> ,( MEDICAL WASTE FACILITY ;OTHER(PLEASE SPECIFY) ANY Elt S <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 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. 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 $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 i /J <br /> CONFIRMED APPOINTMENT DATE TIME w <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD 084t2408 , <br /> emrz000 <br />