Laserfiche WebLink
Mar , 5 . 2002 507P C^MOOR EARTH TECHNOLOGIES No 8600 P - 4/4 /? <br /> lvim END LOG NUMEER <br /> 4V/ �—je <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> !1h ENVIRONMENTAL HEALTH DIVISION <br /> r' 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCK-170N CA 95202 <br /> 02 t'1.' ; 5 Frfi 4 O22 . (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1 p LLQ I 4 ' ' l �(BUSINESSIAGENCY 1 <br /> ADDRESS <br /> PHONE � ��,�1 -FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE i /"` ?Xnin TIME <br /> (Pleaze live to 10 bus esss date of applica n Sub 'ttal) - <br /> / 02 ft <br /> lwmIftor V% <br /> 1 <br /> CHECK BOX TO EX>}SITE REQUEST $87.00 FEE-RE ST �s .3 E 115 AYS <br /> SIGNATURE OF APPLICANT DATE 2 Q - <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 11 96tv N <br /> n=- <br /> to, <br /> -'s <br /> khz RA <br /> `'✓ i Rg� s �_ <br /> f 2002N <br /> I273 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> L'�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT I SOLID WASTE:FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ �Dijn WASTE VEHICLE <br /> 1tT'UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL pAIRY <br /> 09"HAXARDOUS WASTE 40ENERATOR CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> P� TIERED PERMITTED FACILrrY O MOTEL HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> EI TATTOO/BODY PEIRCING ❑ P600SPA - 0 LAND USE APPLICATION SITES <br /> 1"FDICAL.WASTE FACILrTY ❑ PUBLIC WATER SYSTEM © OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type DUST be selected. lax to (209)464-013$ r ailto 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 tater than ten (10) days after receipt of application, The files <br /> will be hold 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 $$7.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END 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 />