Laserfiche WebLink
• • • -•• �'� - LIII)I,OG NUMIIL11 <br /> -S N J( aIJIN COUNTYPUBLIC HEALTH ,' WICES <br /> (_ ' ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR v <br /> DEC 1 1 ZOOZ STOCKTON CA 95202 q67 <br /> (209) 468-3420 <br /> PFRi" I ''`-`LPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT .l�Gcf �K,� l`ZGeCi°�G 13USINESSIAGENCY <br /> ADDRESS F6 S� �y <br /> PHONE ! ` GAG FACSIMILE Gulf <br /> TENTATIVE' APPOINTMENT DATE TIME <br /> (Pleaso givo 7 to 10 business days from dale of application submittal) <br /> 1771 'CHECK BOX TO EXPEDITE REQUEST $89.00 FE REQUEST PROCESSED IN 3 S ESS DAYS Un, <br /> SIGNATURE OF APPLICANT r L DATE U� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 12-'UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑. TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM YOILETS <br /> O TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 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 ton (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 lhat,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 ih 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 $89.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />