Laserfiche WebLink
SAN UIN COUNTYPU LIC HEALTH `� IOES <br /> S14 <br /> VIR.ONMENTAL HEALTH DINT$[ <br /> RU <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIcaNT /�U 1 t f"1' ate) 'S BUSiNESSIAGENCY adIVA !► w/j- IX- <br /> ADDRESS <br /> --}} 1 - /1 P <br /> PHONE4f� � FACSIMILE <br /> O C <br /> TEN'T'ATIVE"APPOINTMENT DATE + TIME O d -- -- z <br /> JPleaue give 7 to 10 b 5tn"s days from date of applicaZon submittal) <:!S. <br /> ®o <br /> CHECK BOX TO EXPEDITE REQU T-$78.00 FEE—REQUE T RO ESSED IN 313USINESS DAYS _ p <br /> SIGNATURE OF APPLICANT DATE <br /> 70 <br /> FILE ADDRESS <br /> p41 N&WQ <br /> Aw <br /> Lc .Q O <br /> S� ► 2 <br /> h 30 <br /> _ <br /> IQ" ,I't&!� <br /> pedo . no P71 lies -*$- Itis I 0Vr D8 . 7hR *1t 50 6-207)%- <br /> ENVIRONMENTAL <br /> —ENVIRONMENTAL H ALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> UN!?ERGCiPL 11ND TANK(MONITORINWREMQVAL) ❑ DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> L3 TIERED PERMITTED FACILITY tl MOTELIHOTEL ❑ PUMPER TRUCKIYARPICHEM TOILETS <br /> © TATTOOIBODY PEIRCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 1PCOTHER PLIIASE SPECIFY Aha <br /> t,. 4lva *so`hc-,D a aldd P, <br /> 1. List up to ton addresses In the space above. Select the twe(s)Of files from the list bove y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to f209, 454-Dl 38 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant H 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 fifes <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 END staff may not be immediately available for review. A new <br /> application may be aubmlttod 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 /> 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 DAVE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 09 14 01OPWO <br />