Laserfiche WebLink
08/16/2004 16:20 FAX 209 9480621 c, U002 <br /> GATE �C I'I����C I FHP LOG NliY9FR <br /> 1l5 .`,J'�.I AN JOA QUIN COUNTYPUBLIC HEALTH SERVICES <br /> AUG 1 6 2004 <br /> ENVIRONMENTAL HEALTH DIVISION q57 <br /> 304 FUST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEALTH - (209) 466-3420 <br /> PEW01IT/SERVICESPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Ff OLVJ BeA.ly BUSINESS/AGENCY \ I.'e11U�"e��P✓� <br /> ADDRESS T O9 S IN <br /> C / i �/� SZ 11 C�e <br /> PHONE dog- 9yg- 3y FACSIMILE 009 - 24"IL O6Y/ <br /> TENTATIVE'APPOINTMENT DATE U �O LO TIME 00 <br /> (Please give 7 to 10 business days Wom date of apPIIUatlon suhmlttal) <br /> 93•eo G �Ij <br /> CHECK BOX TO EXPEDITE REQUEST-$PrftEE—REQUEST PROCESP ED IN 7 BUSINESS DAYS 7 f/ <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY 3 <br /> PROGRAM ELEMENTS SEARCH <br /> to/ '7S i0aV - MS�l7'�3 <br /> D /I / r S 0CC <br /> Q rn/P ✓ .v foc n/ L� <br /> 2eargved Avewile toai <br /> 1 rrrow <br /> S-yz <br /> ? �C J C.P <br /> ENVIRONMENTAL HEALTH DIVISION FILES '- r <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) k HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY F—SOLID WASTE VEHICLE <br /> Jul <br /> UNDERGROUND-TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL )K DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 'pt PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY - ❑ MOTELMOTEL „ yM PUMPER TRUCKr(ARDICHEM TOILETS, <br /> ❑ TATTO015ODY PEIRCING ❑-POOLISPA -" , p LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM 17 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 EHD staff may not be Immediately avail hie for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not retumed 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 /> S. '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 /> —_ .... ndrmw naTr- <br />