Laserfiche WebLink
_ f?j003 w <br /> 1ef28/2004 13:24 FAX 209 948( i', <br /> DATE RECEIVED `: - .SAN JOAQUIN COUNTY <br /> ENVIIWNM ENTAT HEALTH J)EPARTMNT <br /> 304,8 Weber-Ave 3'Floor Stockton,CA 95205 <br /> (209)468-3420 Fax (209)464-0138 Web:www.co-san-joaquin-caus/ehd <br /> .?00000e <br /> Pi)ELIG RECORDS RELEASE APP/nL�I1CA.TION <br /> BUSINESSIAGENCY: <br /> APPLICANT: <br /> ADDRESS: Ogg y�s�- lhlilr'�1�. <br /> PHONE: Oki? FACSIMILE: q +� <br /> TENTATIVE'APPOINTMENTDATE: 1�IIII❑`� Tn+e: �o�•� h <br /> (pteame allarr t0 business days from date of aPPllation subniRtaf) <br /> ❑ CHECKBOXTOOMEDIEREOUEST, $93.00 FEE <br /> —RE4UESTPROCESSEDW3BUSMESS DAYS <br /> SIGNATURE OF APPLICANT � " DATE <br /> DepadmeM Use OdY <br /> UNI <br /> FILE ADDRESS <br /> fin L1't h`Q Unit i <br /> Q <br /> i s G eseka. -V-- r {0.r <br /> Ljn + d Unit ` <br /> � -, / \\ <br /> 4. end <br /> s. sem k <br /> a. seee, 1 Unit <br /> r. sees, <br /> e. spa+ ❑ Unit 5 <br /> s saes h <br /> ENVIRONMENTAL t1EA LTH DEPARTMENT FILES <br /> P) ❑ YEH HOUSING ABATEMENT 0 Sap WASTE CLE <br /> CLEANUP SITE(LOP) <br /> Ot UNDERGROUND TANK WS ) 13 FOOD FACILITY <br /> ❑ SOLID WASTE EHIt-E <br /> is OTHER CLEANUP SIE(NON-LOP) ❑ DOG KENNEL 93- DAIRY <br /> in UNDERGROUND TANK(NIONITORINGIREMOVAL) ❑ CHICKEN RANCH R PKGTREATMENTPLANr <br /> Ll NAzpRDOUSWASTE GENERATOR ❑ MOTELMOTEL ❑ PUMPERTRUCKrYARWCHEMTOILl:75 <br /> ❑ TIERED PERMITTED FACILITY ❑ pOOVSPA )& LAND ITSE APPLICATION SITES <br /> ❑ TATTOMODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> a MEDICAL WASTE FACa]iY checking - <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above¢y <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 0.64 0138 or mail to the <br /> 2• IMIM <br /> India d a Ppve_ y appointment for review will be confirmed <br /> will noG thea licant if an END files exist M aPPo <br /> approximately five business days but no later than ten(10)days after receipt <br /> should i scOn'a les <br /> will be held for a maximum of five business days for review. Appo <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 /> g, Applications received after 3:00 pm will be processed the next business day. <br /> POINTMF_NSDATE .'"� `,S '_::_.": '. ,">:.•... . .. ..:.. . .. <br /> _ ..,,i.PIiONE : FAX:..'.• -;a-;:' . . <br /> iDATE.JONFIRMF� <br /> . . .YES - <br /> REVIE1fVED <br /> . Efao 4a-0zaac <br /> ala2001 <br />