Laserfiche WebLink
SAN JOA� . JIN COUNTYPUBLIC HEALTH SEr . . ICES � — <br /> N 1 pM ENVIRONMENTAL HEALTH DIVISION <br /> \1 �p - 304 EAST WEBER AVENUE, THIRD FLOOR <br /> \ j <br /> �f STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ` ^•'" Q V` �`"'\\ BUSINESSIAGENCY <br /> ADDRESS (A <br /> �-Q« �� `- ��^^ (��c9ss�c (A <br /> PHONE 7 ` �- FACSIMILE <br /> TENTATIVE" APPOINTMENT DATE TIME <br /> (Please gi 7 tale business days from dale of application submittal) <br /> �lN rTS , r,L <br /> W CHECK BOX TOAXPEDITE REQUEST - $07.00 FEE - REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> _ DATE <br /> FILL= ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> (OS �Ir`r'f-- S IF "( <br /> co Z5 OLS t.Nv+ , <br /> 0 3 3 S 4aV�S lA� . <br /> (0�1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 3DERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ADATEMLNT ❑ SOLID WASTE FACILITY <br /> HER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> X UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL - ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIE- RED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PHIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTL FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ton addresses in the Space above. Select the types) of files from the list above by checking <br /> ttic appropriate box(es). At least one file type MUST be selected . Fax to (209) 464-0130 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 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 ap f(licant. Future file reviews by the same applicant may require a $ 07.00 deposit prior to review. <br /> 5 . *TENTAT.NE 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 /> lH oo ti oa/01140 <br />