Laserfiche WebLink
DATE RC�EIyE�L EHD LOG NUMBER <br /> j�/ M���` SAN JOAQUIN COUNTY <br /> •F-c7 i-'. \I L=`-J ENVIIZONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Elm Stockton, CA 95205 <br /> S E�' 20)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca,us/ehd 0q0 <br /> FNVIRUivM f l Hl-, .i 11 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:—30\v\r) ` C%f\e. BUSINESS/AGENCY: 6,0VnCX zol A'Na'\\Is„f--, +r:.r <br /> A <br /> ADDRESS' Ma\A pL75p . Esc-alon, LA /^9_5'32-0 o <br /> PHONE: �2-Q�1� $�,S—CA A d b FACSIMILE: l L� 3 y—g 6 dp <br /> 3 <br /> TENTATIVE`APPOINTMENT DATE: V 0� Tlmo: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$93. FEE EQUEST PROCESSED IN 3 BUSINESS DAYS 1L <br /> SIGNATURE OF APPLICANT o DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> s 3 50 nz,a <br /> z. sheel <', . T I city [ Unit 1 <br /> a. sco« city ❑ Unit 2 <br /> 4. she& cir <br /> 6. Strggt Cil <br /> SwUnit 3 �,��> <br /> 8. pt C �.. f <br /> 7. slued orf Unit 4 V <br /> 8. sheet city <br /> 51. sheet CAY Unit 5 <br /> ,o. sueel <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JR UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> JW OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> '9 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> JZ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> bil TIERED PERMITTED FACILITY M MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING a POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY © OTHER(PLEASE SPECIFY) <br /> 1. List up to tan 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 EHp 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHO A8-02-008 <br /> gamo9 <br /> Td Wd60:b0 POOE 6Z -daS 2886 820 GOZ ON SNOHd sisFi(eud oaaZ punoaO : Wod_d <br />