Laserfiche WebLink
DA i M <br /> SAN JOAQUIN COUNTY LiiLlwlalVui,liiL1: <br /> EN ,-)KONMENTAL HEALTH DEPART!~:tNT <br /> UEG 1 6 2003 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquill.ca.t>s/chd Lot'kL+d i f KALI i7 <br /> "t 'T SE VICES PUBLIC RECOIZDS RELEASE. APPLICATION <br /> APPLICANT: F `/ . BUSINESSIAGENCY:-�1�GL <br /> ADDRESS: 60 u 4x1- / <br /> _54 <br /> t �" G <br /> PHONE: � - FACSIMILE: I <br /> 0 6 <br /> TENTATIVE*APPOINTMENT DATE: Z""r !l:c) <br /> (Please allow 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 F -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. .�itrccl CitLIA <br /> 2. street �,tY ❑ Unit 1 <br /> 3. Skeet Cil <br /> < Street C,t pill <br /> 2 <br /> 5 5ueei Cd <br /> -- — �- ❑ Unit 3 <br /> 6. strut Cit <br /> 7, Street Cil <br /> ❑ Unit 4 <br /> e. street crly <br /> 9. Street Cil <br /> -� ❑ Unit 5 <br /> It 10 Slreel Cil, <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(MON ITORINGlREMOVAL) O DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKFN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 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 /> 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 /> 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 /> *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 /> OONFIRMED APPOINTMENT DATE ZZ—Al, 3 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED C� NO REVIEW DATE <br /> 518800] <br />