Laserfiche WebLink
UN I L: KCI.CI V CU SAN JOAQUIN COUNTY - <br /> ENv:_ _ JNMENTAL HEALTH DEPARTNi_ _dT <br /> II 304 E Weber Ave 3dFloor Stockton, CA 95205 <br /> 1 (209) 468-3420 Fax: (209) 464-0138 Web : www.co.sanjoaquin.oa.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION I <br /> APPLICANT: S 0.)CI�q 1/� �' I BUSINESS/AGENCY: <br /> ADDRESS: � / / U, , Gl4F "P C•� r � C' LIVj/ ✓ 10 2� <br /> PHONE: FACSIMILE: <br /> TENTATIVE` APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST - $9 :6�FEE — REQUEST PRO ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ( DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 35242 1. su«e 5-7"5- Citync eu� �.v^772 c . l,,...ic-(cam-1-, .J <br /> lI`30 z. sues Com' T � SYS ❑ Unit 1 <br /> 3. slrte cdy <br /> eine city <br /> ❑ Unit 2 �(A�' <br /> 4. s <br /> S. 5e atyUnit 3 (/ <br /> 6. $Lee City <br /> T. sate! CRY <br /> Unit 4 <br /> S. sbe CKY 10, <br /> s. suet City ❑ Unit 5 <br /> 10. s6 Qty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY - ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOMODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <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. . 1 ' <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. <br /> CONFIRMEDAPP ' INTMENTDATE% TIME <br /> DATE CONFIRMED HPHONE FAXiNIT14LS <br /> REVIEWED YES NO REVIEW DATE < <br /> EHD 4"2406 <br /> 6!82001 - - <br />