Laserfiche WebLink
DATE RECEIVED ~. EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ��1.�; �; - • ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> OCA 1 <br /> (2 09)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Y'� t �u C C Z) BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE: -�TrD FACSIMILE: �7�c1- 1'7211R, <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE R <br /> Department Use Only <br /> �L f+FILE ADDRESS UNIT <br /> 1. Street 1. 0-4 N. Sc-Vk "O\ J'f aty LAC <br /> city Sid Gt4�b�• Z GO El Unit i <br /> �,�(ip/ 54. street Zle SI S R�� a. W G Ski cicfi av: 7 t ❑ Unit 2 <br /> 4. Street 151 aty S',o-Z. e-` v--\ <br /> S. Street 51'� E. M a-Z V, S-N. city N� Unit 3 <br /> 6. Street 3� I O C A)ra"y <br /> 7. so-eec ftv--l- A)nt, Unit 4 <br /> 8. Street rtv ld FG <br /> s. Street,/ f S 1 S t; , 01 cU n S� ./�, F G S+VLI—A-m nit 5 <br /> 10. Street l' �I N �n{ rUY� ( 1 ��° a S 1 t3 �t�fP'� 7 <br /> ct��e 11`tnl� (C v�l� <br /> - � kl ENVIRONMENTAL HEALTH DEPARTMENT FILES �k <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 /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOL/SPA ❑ 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 rexieS <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. AID <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED. ►PPOINTMENT DATE a_,:_ TIME <br /> DATE CONFIRMED FAX'" INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 <br /> 8/8/2003 <br />