Laserfiche WebLink
09/17/2003 09:37 FAX 209 9480621\ q <br /> 0004/004 } <br /> r <br /> [}AiE RSGEIVED i E}41 LOG X[Dilm <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION. <br /> 304 EAST WEBER AVENUE,THIRd FLOOR <br /> -SE1STOCKTON CA 952D2 'I <br /> P .2 �� (209) 468-3420 ,7 <br /> -fvVIRUNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ITLT <br /> APPLICANT ,V I BUSINES$IAGENCY �-�'1✓s r.1 � I�(L <br /> k <br /> ADDRESS } w <br /> PHONE Zc�g_ FACSIMILE_ 40'q 9�i� off,J <br /> TENTATIVE"APPOINTMEWl'DATE �l O ; TIME <br /> (Please give 7 to 0 business days from dale of application submittal) <br /> CHECK BOX TO EXPEOWE REQUEST-S87•oo QUEST P ESSED IN 3 BUSINES5 DAYS <br /> t1A1 t <br /> I 1/� <br /> SIGNATURE=OF APPLICANT f DATE `�7 <br /> I FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> I PROGRAIN EEMENTS SEARCH <br /> D <br /> ,//1"-90t40 4- L tih fv'I <br /> 0 i? J S`. �, L, IX <br /> cfl It rt <br /> . tr {� Q <br /> 35 kr I I <br /> 3 M . [nrl�5�l.1 WA'' t, T <br /> 11 M <br /> ,t l <br /> f'lT'+/' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT � W sat1D WASTE FACILITY f <br /> IP OTHER CLEANUP SITZ~(NON-LOP) ❑ FOOD PACII.RY ,j 0�SQIJD WASTE VEHICLE <br /> 41 UNDERGROUND TANK(MoNITORINGIREMOVAL) 0 DOG KENNEL illi 1,DAIRY <br /> �1 HAZARDOUS}HASTE GENERATOR CI CHICKEN RANCH ® PKG TREATMENT PLANT <br /> d TIERED PERMaTED FACILITY ❑ MO7EuHO� } 0'�PUMPER TRU KrYARDICHEM TOILE'T5 <br /> TAT-rOOIB00Y PEIRCING O•POOuspA &r (AND USE APPLICATION STn_s <br /> [7 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVQ <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking ' <br /> the appropriate box(es). At least one file type MUST be selected. Fix to 209 64-0.138 or mail tot e <br /> -address Indicated above. . ' 4 <br /> 2. EHD will notify the applicant if any EHD riles exist. An appointment for review will be confirmed. <br /> approximately five business days but no later than ten(70)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 /> E 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 CeorpanIzed'by EHD staff et 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 states must be confirmed with EHD staff. <br /> 6. Applications received after 3;00 pm will be .rocessed the next business day. <br /> Y <br /> CONFIRMED APPOINTMENT DATE TIME_ <br /> DATE CONFIRMED <br /> PHONE FAX INi77A>,S <br /> REVIEYVI=D . YES No REVIEW DATE _ <br />