Laserfiche WebLink
DF-RECEIVED <br /> �\rlre In\I SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> I,F)A �.��' 1 J L - ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOVRR 2004 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> z0 <br /> ( )468-3420 Fax: (209)464-0138 Web: WWW.co.sanjoaquin.ca.us/ehd <br /> ENV � Z13 <br /> ERp,rjTrISERVICES H <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C I/I /�i� BUSINESSIAGENCY: <br /> ADDRESS. <br /> PHONE: v <br /> FACSIMILE: <br /> TENTATIVE` POIN MENT ATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE RE UEST-593.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. Street 2O( U S'. �c- Au 4-A-AC city l <br /> ❑ Unit 1 <br /> 2. Street oty <br /> 3. Street city ❑ It <br /> 4, Street Ci <br /> 92-4 <br /> 5. Street G <br /> Unit 3 <br /> 6. Street - �� <br /> 7. Street City ;i <br /> Unit 4 <br /> 6. Street City <br /> e. street aty ❑ Unit 5 <br /> 10. Street oty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOf�) ❑ FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITO INGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AU- HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES Nk <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addre ses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate tion( s). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated a ove. <br /> 2. EHD will notify theapplicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five b}�siness days but no later than ten (10) days after receipt of application. The files <br /> will be held for a m%mum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively IbIeing worked on by EHD staff may not be immediately available for review. A new <br /> application may be sl bmitted when the file is available. <br /> 4. Any file not returnedlin the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Fut lure file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointIment 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 /> EHD 4"2-006 <br /> MnO03 <br />