Laserfiche WebLink
Booz <br /> 09/127n/t;2004 16:13 FAX 209 9480 en 4v <br /> c �civ CuSAN JOAQUIN COUNTY .. . <br /> n�_ - )� ENvIRO NMENT'AL HEALTH DEPARTMENT <br /> Q`l� 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> SEP 2 7 ZGO&04)468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquin-muslehd <br /> ENVIRoi `',',` ,r r, H�TN PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �Z KK, iJ :� J) uustNr S/AGENCY: <br /> ADDRESS: /1r�.• �So�.1 �- �EY �r �")"k151 p <br /> PHONE: FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 40/7 Time: R� <br /> (Phase allow 10 business days from data of appli.-lion zubmkta0 <br /> E3 CHECK BOX TO EXPEDITE REQUEST.$33.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT "—�� �! �S'L DATE <br /> DeoarbneatUse OW <br /> FILE ADDRESS - rUn�ltt23 <br /> s.ea ao 2s� R a <br /> 10 <br /> �0n 3. saes, v aaI- -frr`, 4. Sbtet t G 7 <br /> S.W l I/�J an <br /> 6. Spee{ <br /> Lid- <br /> sea <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES x <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT BLSoUD wA=FACIf_" <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE YEHICLE <br /> a UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 19.DAIRY PLANT <br /> ZHAZARDOUS WASTE GENERATOR D CHICKEN RANCH p TREATMENT <br /> ARDlCHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY O MOTEtIHOTEL PUMPP <br /> P POOUSPA ®• LAND USE APLIGATION SITES ,. <br /> ❑ TATTOCISODY PIERCING OTHER(PLEASE SPECIFY) <br /> C3MEDICAEOICA L WASTE FACILITY PE - <br /> 1. Ust up to ten addresses in the space above. Select the type($)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)4114-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant It 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. Appointment$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 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 /> CONFIRM801K. POINTNl5N7D&B i s r:rr.• TIME _ N <br /> �ATE0ONF).RME[i . . . ' <br /> M1:rPHONE i FAX ;ll'';: 'AN 'S - <br /> I2EVIE1IVED YES NO REVIEW DATE' <br /> eHc 44-92-9$9 . <br /> aana� <br />