Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquinin.ca-us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L '✓M � BUSINESSIAGENCY: lYofS.7yeJ�G'u ^� <br /> ADDRESS: ('d�Ox �-✓� 64 <br /> PHONE: z1g-voo FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQ U -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. street /ot/ ,< ,Sa.� �.. ,,.'„ s , a S ^� T A (n� Unit 1 <br /> 2. Sheet `l4 S h,�/�.ws �1 7oGoM�• u nn�fa— f a nt G <br /> 60 zel .J /7llt.P G CIA ✓ 5T ❑ Unit2 � � �� <br /> i. street ((O�I�tYjCe - ' <br /> 4. Street oty <br /> s. Street 3 <br /> 6. Street Q <br /> 7. Street 0 Unit 4 <br /> 6. SVeet Q <br /> 9. Street <br /> G ❑ Unit 5 <br /> 10. SV"( Q <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> K UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ElTIERED PERMITTED FACILITY 13MOTELIHOTEL 13PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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$93.00 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD"42-006 <br /> 6 003 <br />