Laserfiche WebLink
-----9/09/2005 12:05 FAX 209 94 1 �002/02 <br /> All <br /> �� <br /> SAN JOAQUTN CO C7. <br /> 2005 ENVI 0n1ENTAL a LTH DEPARTIY]MNT <br /> 304 E Weber Ave 3 rdFloor Stockton, CA 95205 <br /> WIPOINI,MENT HEALUM)468-3420 Fax: (209) 464-0138 Web:www.co.sm-joaquia.ca-us/ehd <br /> PERpy"TI SERVICES 1q7 q' . <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APFI- Al T: K C,(-eA___�� -BUSINESSIAGENCY: x ( C—tnl P1(-1,1 0r-, 1 to C <br /> ADDRESS: <br /> ptioNE• L`to' ' f3 � FACSIMIIF: <br /> TENTATIVE'APP61NTMENT DATE Time: <br /> (Please allow IQ business days from date of application submittal) <br /> CHECK BOX TO EXPEDrrE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Departrnent Use CON <br /> FILE ADDRESS UNIT <br /> s.ed Z 1 oty TkAul ❑ Unit 1 <br /> 17 b G Unit 2 <br /> 4- ska —1 City <br /> i_ Stied G <br /> r. <br /> 13ty unit 4 <br /> bm sOw - I X <br /> 5J <br /> 00.0 s. s-W p ❑ Unit 5 <br /> �(0 -ENVIRONMENTAL HEALTH DEPARTMENT FILES Of X Q <br /> CLEANUP (LOP)UNDERGROUND TANK(UST)G 13 HOUSING ABATEMENT RL SOLID WASTE FAC ury <br /> ) <br /> OTHER CLEA24UP SrrE(NON-LOP) ❑ FOOD FAcil_f)Y ❑ SOLID WASTE VEHICLE <br /> I& UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL EL DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKI=N RANCH R-PKG TREATMENT PLAW C <br /> ❑ TIERED PF.RMFMD FACILITY ❑ MOTELINOTFL ❑ PUMPERTRUCKIYARDICHEM7011L <br /> ❑ TATTO01HODY PIERCING ❑ POOL/SPA Ca LAND USE APPLI ON SITES `�\�_ <br /> ❑ MEDICAL WASTE FACILI Y In OTHER(PLEASE SPECIFY) f <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the fist ah!F" <br /> checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)46.4-0136 or mail to the �Vv <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 ' r <br /> will be held for a maximum of five business days for review. Appointments should be scheduled C� °�,� <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 sante condition as released will ha 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 /> S. 2TENTATNE appointment dates must be confirmed with EHD staff. lie <br /> 6. Applications received after 3:00 pm will.be processed the next-business day. <br /> -_GZ7NF�RM D.-APP�INT), mf-BATE` `r � -TIM <br /> DATE CONFIRMED "PHONE . FAX ' -'INITIALS <br /> REVIEWED YES NO REVIEW PATE' ' <br /> ' GHn•n..nosnG <br />