Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton. CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web: wwA-.co.san-joaquin.ca.us/ehd <br /> i PUBLIC RECORDS RELEASE APPLI�C/ATION <br /> APPLICANT: LTC,1./F�_ �r1 f BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE: �20 .,31��`� yy I FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: O Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS U <br /> SIGNATURE OF APPLICANT /"'ADATE <br /> Department Use Use Only <br /> ,• FILE ADDRESS ( ,c UNIT <br /> 1. Street S 7n� !`� . I--�w' /57c S C!'['/ eJ ❑ Unit 1 <br /> 2. Street Crty <br /> 3. Street cfty ❑ Unit 2 <br /> 4 Street city <br /> 5. Street city ❑ Unit 3 <br /> 6. Street city <br /> 7. street Cq ❑ Unit 4 <br /> 8. Street cfty <br /> 9. street Crty Unit 5 <br /> 10. Street C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 'ft OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 nm wI be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME If <br /> r <br /> DATE CONFIRMED V/ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-008 <br /> 8/8/2003 <br />