Laserfiche WebLink
t 12:34 FAX 925 945 6.485 WEST—Ov—"AUT CREEK to902/002 <br /> 07/22/£nk 41a4013E "+ ENVIRONMENTAL �'` �:Fi PAGE 01 <br /> .•+wa <br /> EH �OG IIWYWM <br /> �SAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 1199 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 7�-3 <br /> c, (209)468.3420 U / <br /> 2' UI3LIC RECORDS RELEASE APPLICATION. <br /> AI�i'L1CAbITVA. t A I LIQ BUSINESS/AGENcY'_1nl e soon Scs ju k'o✓ls., _[+k'e <br /> ADDRESS 1 �r 5 Trca. 1 l v \n}a �- 1� `�5.4 <br /> PHONE 9 2S rq'!5 ��-i 5 LoR 2 5 r 9 S - �} S <br /> FACSIMILE <br /> TENTATiVE*.APIOn+MENT DATE. 30 f 2 TIZAE 10; 00 <br /> lease lie 7 to 79 tx�iness data of a kation xu5mitlal <br /> CHECK SOX Ta E)CPFnM?REQUEST-Wbf)FEE-REQUEST PR �®I 3 l3USINESS DAYS K <br /> SIGNATURE OF APPLICANT DATE D-z— <br /> SIM ADDRESS THis SIDE EHD STAFF USR r <br /> PROGRAM ELEMENTS SEMORI <br /> GIl �tx��lori4 S - �roC,1c. r1 <br /> e <br /> Z. S. wr le►�q `� <br /> to <br /> mn,n kid <br /> EWRONMENTAL HEALTH DIVISION FILES <br /> • , S <br /> UgrlRRGROUND TANK(U911 CLEANUP STIR(LOP) Q HOUSING ABATEMENT soLiD WASTE FACILrryS <br /> OTHER CLEANUP SITE(NODI-LOP) M FWD FACILITY ❑ SOLM WASTE VEHICiF'�: <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) LO DOG KENNEL is DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT <br /> TIERED PERMrrMV IrACILIry O MOTELIHOTE.L 0 PUMPER TRUCLUY R 11gM'ToIIETS <br /> 0 TATTOO/BODY PFIRCINO 0 POOUSPA 0 LAND USE APPLICAT(W SgES <br /> E3 ydI;DICAL WASTE FACILITY <br /> Q PUBLIC WATER SYSTEM a OTHER(PL EASE SOetiltY ABOVE) <br /> 1. List up to ten addresses in" the space above. Select the type(S) of files front the list above.by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 64-0138' • mall to the <br /> address lndicated abaye. ' <br /> 2, EHD will notify the applicant if any EHD files exist, An appointment for review will be oB�irmed <br /> approximately five business days blit no later than ten (10)days after receipt of appiic ftn. The files <br /> will be held fol'A maximum of five business stays for review. Appointments should be 9&eduled <br /> accordingly. <br /> 2. A file that Is aci'.ively'beiny worked an by IEHD staff may not be immediately available 10�..oview. A new <br /> application mail be submitted.when the file is evallable. <br /> 4. Any file not retrlrhed In this same condition as released will be reorganized by END s'taffel t the expense <br /> of the applicant. Future lite reviews by the same applicant may require a 589.00 depa�It'prior to feviOW. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. . <br /> CONFIRMED APPOIN'1.MENT DATE.- TIME <br /> DATE CONFIRMED _ PHONE FAX -INITIALS.... <br /> REVlt_WED YES NO REVIEW DATE <br /> 14 nr <br />