Laserfiche WebLink
WJ/U1/21Jb4 .12:41 2073-579-2.225 MODESTO ATC PAGE F11. <br /> DATE RECEIVED EHD LOG NUMBS <br /> In SAN JOAQUIN COUNTY <br /> I ('L�r WE E�ONMMNTAL HEALTH D TWNT <br /> SEP 0 1 2004 304 E Weber Ave P Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.caus/ehdIq 815 <br /> CNVirsuillVIENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PE� 't,L1T1..F VIG€{{��� , I /�l.l. --- <br /> APPLICANT: Uf cw V QH 0-t,- BUSINESSIAGE14CY: AT Q- _ <br /> ADDRESS <br /> PHONE: Z� Z 7-7-'Lt FACSIMIL :I -L ',o 1 51 q <br /> TENTATIVE*APPOINTMENT DATE: L � Time: Q I �q <br /> (Please allow 10 business days from data of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$93 00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT D U -/s" " - DATE <br /> bzf S i S "{ 1h (��z tt rKe,.-j D+aartment Use Only <br /> FILE ADDRESS UNI' <br /> 35zp ,. eo..c 5`oco Cfts c K �tx-5t 14AL;42 1.16 <br /> i s. 51 51 4L,. LL a S A1C wt 4- Q Unit 1 <br /> 3 5�� 3. str..� L� �y ,c V t�.� y S�Lk �' `5 [� Unit 2 <br /> 35 4 • hdt_\ LL Aq e,aNA Mys ��40-1 <br /> 34rA--L - S CK -1 Unjt3 <br /> 3 S D7 V e. sa.er Z }� !; r-t..,r,LLN (4 9-4 . ca, 1-krf At t-ti <br /> �5a7 j03:5 W. %4-,-t CN SAte tvUn* <br /> asaz- `tea. ea.a 7-43•"3 N. W d4- Lko-t: S Lk <br /> 35a-7, %2 ..r ' q SE} i - Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY d SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL O DAIRY <br /> W HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH O PKG TREATMENT PLANT <br /> li TIERED PERMITTED FACILITY ❑ MOTEUHOTEL C PUMPER TRUCK/YARD/CHEM TOILETS <br /> f TATTOOBODY PIERCING [] POOLtSPA ID LAND USE APPLICATION srms <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 Ilat above by checkin8 <br /> the appropriate box(es). At least one file type MUST be selected. Fax it) 2291 4138 or mall to tt1Q <br /> address indicated abovQ. <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 flies <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 ne% <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 expens( <br /> of the applicant. Future file reviews by the same applicant may require a$93.02 deposit prior to reviev <br /> S. *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 P14ONE <br /> REVIEWED .- YES NO REVIEW DATE <br /> CHO;MMIM -0w <br />