Laserfiche WebLink
J MAR-08-2002 _ 16:27 CAMBR I A 1707 935 6649 P.01101 <br /> t.�io L.n;NUMULK <br /> SAN JOi AN COUNTYPUBLIC HEALTH SE CES <br /> :.'.. l`_E_�=,l-1 ON <br /> 304 EAST1WEBER AV NMENTAL H UEJ,THI DFLALTH OOR <br /> STOCKTON CA 95202 7 1Z <br /> (209)468-3420 <br /> 021-11 -9 Pr' IPALIC RECORDS RELEASE APPLICATION <br /> APPLICANT Ack6-�- tet BUSINESS/AGENCY <br /> �4 1 <br /> ADDRESS 2—T O /C CA <br /> PHONE 707 933- 23(a 8 FACSIMILE 001) :/p35 (049 <br /> TENTATIVE'APPOINTMENT DATE_a — k 9 TIME Q Q O <br /> (4PS4801LIPEST <br /> ' T to n daysA;ED <br /> et ap !cation submittal) <br /> CHECK BOX TO EXPEDITE RE P IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'T"-� y"�-' DATE 3 45 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> M-1-100 Nkbre uY <br /> t U�1. lnSY4�X S G4 <br /> ✓✓ O W. G ar W <br /> !�►ncolh S <br /> L-:tsn CA I to St*-te} K T <br /> N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> D <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) EO HOUSING ABATEMENT 171 SOLID WASTE FACILITY <br /> XOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONTTORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> LJ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH d PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKlYARD/CH9N1 TOILETS <br /> ❑ TAT700/80DY PEIRCING la POOL/SPA - ' O LAND USE APPLICATION 51TES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 EHR staff may not be immediately available for review. A now <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$87.00 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> TOTAL P.01 <br />