Laserfiche WebLink
OwTE liLC.E1VEn <br /> ' SAN JO " 'ZIJIN COUNTYPU131.IC HEALTHSF ^VICES EHD LOG NUMgF <br /> VIRONMENTAL HEALTH 171)[1510 • n <br /> 304 EAST WEBER AVENUE, THIRD FLOOR 64 <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT . a-rt B01NESSIAGENCY avtdOv' [=.c <br /> ADDRESS lf� Fwink WB,S 1T C..,.; {.� T S {"w� r.k-I-ov< CA 952b td <br /> PHO41 - 2. LA4 - 40SFACSIMILE <br /> � Oy <br /> TENTATIVE* APPOINTMENT DATE _ TIME <br /> (Please give 7 to 14 baakmas days from data of eppJication SL"nm l) <br /> UtiirL5 a, 3 , L <br /> CHECK UOX TO EXPEDITE RFQUES�T/- $&7,00 FEE — NEROCHSSEU IN 13USINM DAYS <br /> SIGNATURE OF APPLICANT %r LIUEST DATE <br /> FILE' ADORi:SS THIS SIDE EHD STAFF USE ONLY <br /> _ PROGRAM ELEMENTS SEARCH <br /> 5^1 v nl_ rl`u. i+ +e.r s f-, _ ag • 5D 1✓l 4 <br /> 4 d 1 Al . )J,�.ra-tea- %•t'. _ <br /> tn'12 , J✓ + �nFty 5f , <br /> Sze J..t . '�Sa J00q- sin S+' <br /> HSM ri <br /> ENVIRONMENTAL HEALTH DIVISION IBES <br /> ; NDFRGROUND TANK (U5f) CLEANUP SITE (LOP) 0 HOUSING AUATEWNT I�SOLID WASTE FACILITY <br /> L'd PTHER CLFANUPSITE (NON-LOP) q FOOD FACILITY IR SOLID WASTE VEMCL6 <br /> [pr UNDERG ROUND TANK (MONITURINGfREMOVAL) 0 DOG MNNEL U DAIRY <br /> 12r HAZARDOUS WASTE GENERATOR 1.1 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Q TIERED PERMUTED FACILITY R MOTEUHOTEL 0 PUMPER TRUMYARD/CHEM TC 3LET5 <br /> 0 TATTOOfBOUY PEIRCING t7 POOLISPA -- • iQ LAND USE "PLICATIONSITES <br /> t9'MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 OTHER (PLEA$C SPECIFYABOVE) <br /> 1 . List up to ton 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 to1209) 464--738 or mail to the <br /> address indigtgd ataoye. <br /> 2. EHD will •Ilotify 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 Tile 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 roviews by the same applicant may require a $87.00 deposit prior to review, <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s. App[Icatiens received after 3=00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _ _ _ PHONE FAX INITIALS <br />