Laserfiche WebLink
k7AIk 4/2002 10:38 2094671118 AGE STOCKTON PAGE 01/01 <br /> VAlk N4/200 <br /> qgS40 JOAQUIN COUNTYPUBLIC H I�SERVICES FHe LOG NuraEa' ENVIRONMENTAL HEALTI� 304.EAST WEBER AVENUE,T16 FL°U <br /> STOCKTON CA 95202a-'� , <br /> W ` (209)468-3420 <br /> PLI LIC RECORDS RELEASE APPLICATION <br /> S APPLICANT /lV - USINESS/AGENCY <br /> ENVIR��I1ENT h o D <br /> PERNITI'�' o?Q d . <br /> PHONE FACSIMILE_ �/y / <br /> POINTMENT DATE O °TIME O <br /> �S6a' (Plsase iva Ito 10 basin da from daf of appllcallon suhmlttal) <br /> PERMIT <br /> CHECK BOX TO EXPEDITE REQU T-$78.00'—REQU O E ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> C2 r <br /> �n►t I <br /> a ) <br /> V v�N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA7ARDOU3 WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRucKrYAKD/CHEM.TOit EfS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 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 hox(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 now <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$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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 0tWd00 <br />