Laserfiche WebLink
SAN JO'' JIN COUNTYPUBLIC HEALTH S VICES i <br /> LeJIRONMENTAL HEALTH <br /> No, 304 EAST WEBER AVENUE, THIR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> D <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> `� r 1 BUSINESSIAGENCY <br /> `APPLICANT�`►C�\L_,.l_./�.�� .._� <br /> ADDRESS //°°��� �-�J .s//�1��C (^� ' (�► <br /> PHONE 6) FACSIMILE <br /> ,.....,gee <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7-to 10 Business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQ UES -$87. 0 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> III FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> II PROGRAM ELEMENTS SEARCH <br /> FC <br /> ENVIRONMENTAL HEALTH DIVISION 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 /> ID UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 P MPER TRUCKIYARDICHEM TOILETS <br /> d TATTOOIBODY PEIRCING ❑ POOLISPA ND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ID PUBLIC WATER SYSTEM L7 OTHER(PLEASE SPECIFY ABOVE) <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 $87.00 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 /> L <br /> ED APPOINTMENT DATE r3 t TIME <br /> IRMED PHONE FAX IN TIALS <br /> YES NO REVIEW DATE-- <br />