Laserfiche WebLink
Geo-Phase Ervir-cinment.al^?nc. FAX NU. : 2095690295 I`1s.r-. 05 2001 12:56P11 P2 <br /> �Iff <br /> D D ti�♦JlOC WVMUEN <br /> SAN J�QUIN COUNTYPUBLIC HEALTH SE�IICES <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> MAR 0 5 20 . 1 304 FAST WEBER AVENUE,THIRD FLOOR /1 <br /> '' STOCKTON CA 95202 f't <br /> ENVIR j' -I 1T (209)468-3420 <br /> Ir` ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLI rsustNE=SSrAGerlcy <br /> r O E 7 O 3 FACSI1wL> �_�9 '002�5� <br /> l ENTATIVE"APPOINTMENT DATE _ TIME , <br /> (Please give 7 to 10 business days from date of application submittal) < <br /> N/ <br /> CHECK BOX TO EXPEDITE REQUEST-jyeT0 FEE—REQUEST PROCE$SEb IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT y DATE <br /> —y-5:72 lj� <br /> FILE ADDRESS <br /> a .400 IqAr ,s L .�r,v�f,y Et _? 9 <br /> 7 <br /> r 1!7A fs rs 3s tet, ' I <br /> r <br /> S <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 94 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ASATEMEHT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 91,UNDERGROUND TANK(MONITORINGIRE.MOVAL) O DOG KENNEL ❑ DAIRY <br /> C HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUROTEL O PUMPER YRUCKIYARDICHEM TOILETS <br /> Q TATTOO19ODY PEIRCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE EACIUTY D 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 /> "s. 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 some condition as released will be reorganized by 1=HD staff at the expense <br /> of the applicant, Future file reviews by the same applicant may require a$78.00 deposit prior to review, <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWED YEs NO REVIEW DATE <br /> Ex a0 7a O1/0'SiOo „ <br />