Laserfiche WebLink
t 12:34 FAX 925 945 6485 WESTOu-"��T CREEK Q902/002 <br /> 07/22/4vtsuz w eU 464013E?_' _ ENVIRONMENTAL HF_TH PAGE 01 <br /> '01 <br /> f 4•rwrcu , <br /> wimm <br /> YJAQUIN COUNTYPUBUC HEALTH SERVICES � ��� <br /> M ENVIRONMENTAL HEALTH DIViS1ON <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> t (209)468,U20 v 3` S X-3-3 <br /> ONRLIC RECORDS RELEASE APPLICATION '.'. <br /> APPLICAlJ1' <br /> 9US9NE=AGENCY 'W esk-on Sn JM�3 ✓ts: •;(,nc . <br /> ADDRESS t S �r�LBa. ��V W L% V e-k 43 q S.c7 - <br /> PHONE -12-5 q'Z S ,5{P FACSIMILE Q 2 �j �7�S �' + S <br /> TENTATIVE*.APIPo1NTMENTDATE 1 3c) U 2 <br /> (P1BM, 1rs ss �Dia fca4[on mulrmFl3at) . <br /> CHECK BOX TO EXPEDITE REQUEST_$89.00 FEE-REQUEST R ®I 3 BUSINESS HAYS <br /> SIGNATURE OF APPLICANT DATE F r o 1z_ <br /> VILE ADDRESS THIS SIDE EHD STAFF UsH r <br /> PROGRAM ELEMENTS SEJUI <br /> 30 *► 504135C 5 ds�63 r? a <br /> R l ��+�Lo+I► cic nIV <br /> [JZ. S. it rL�q "Yl <br /> w avi b '71ff <br /> ALA M. <br /> I <br /> vn o r► h p/t <br /> ` I <br /> Z V%d <br /> aa) l N1+ v <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> J�UNDERGROUND TANK(11$11 CLEANUP SITE(LOP) 17 HOUSING ABAIMMRNT A SOLID WASTE FACILITY.. <br /> �3 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FAMMY 0 SOLID WASTE VEHICL-%-; <br /> UNDERGROUND TANK(MONrl ORINOMEMOVAL) O DW XENN-L ' 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICK>wN RANCH 0 PKG TREATMENT <br /> TIERED PIERMrrrED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCIUY RfJPd11EM T0146TS <br /> 0 TATTOOMODY PEIRCING 1:3 PooLISPA A LAND USE APPLICATIbW SrfES <br /> T] mCwCAL WASTE FACILITY d PUBLIC WATER SYSTEM In OTHER(PLEASE SPECIrtY ABOVE) <br /> 1. List up to tort addresses in the space above. Select the types) of files from the Ilst above.by Ct ecktng <br /> the appropriate box(es)_ At least one file type MUST be selected. Fax to 209 640138 ' mall to the <br /> address Indicated o e <br /> 2. EHD will notify the applicant of any EHD files exist. An appolntmentfor review Will be od(7rmed <br /> approximately five business days but no later than ten(10)days after receipt of applirat'Ii+n. 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 1s actively being worked an by EHD staff may not be immediately available ftsview. A new <br /> application may be submitted.when the file Is available. A <br /> 4. Anyfile not returhed In the same condition as released wilt be reorganized by EHU A&I11*at the expense <br /> of the applicant. Future file reviews by the same nppllcant may require a$139.00 depot jj'prior to review, <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:0C pm will be processed the next business day. . <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS rte„•,.,,,,,,,_�, <br /> REVIEW DATE1115"IEWED YES NO <br /> I <br /> I, <br />