Laserfiche WebLink
DATE RECRVF0 EP1 �jS NUMBER <br /> SAN JOA` d IN COUNTYPUBLIC HEALTH SE ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 344 EAST WEBER AVENUE,THIRD FLOOR 200,j <br /> STOCKTON CA 95202 <br /> r1 <br /> (209))468-334220ir,fL!11 PUBLIC <br /> RECORDS RELEASE.APPLICATION <br /> Smc,�csumwaw - �i a -• ��)j L+�r- <br /> APPLICANT BUSINESWAGENCY Phi=i= 00f -IDC- <br /> ItADDRESS V I " <br /> PHONE_ [xJIJ T �a FACSIMILE <br /> TENTATIVE*APPOINTMENT DATETIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$715.00 FEE-REQUEST PROCESSED IN:3 BUSINESS DAYS <br /> SIGNATURE.OF APPLICANT ��-'� --- DATE I <br /> FILE ADDRESS <br /> 1 t <br /> f ', <br /> 3 <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> 39 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ SOLID WASTE FACILITY❑ HOUSING ABATEMENT b SOLID WASTE VEHICLE <br /> til OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY 0 DAIRY <br /> 19 UNDERGROUND TANK(MONITORING/REMOVAL) © DOG KENNEL D PKG TREATMENT PLANT <br /> ;R HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH p PUMPERTRUCK/YARD/CHEM T(11 LETS <br /> ❑ TIERED PERMITTED FACILITY E3 MOTELIHOTEL ❑ LANE?USE APPLICATION SITES <br /> ❑ TATTOOtSODY PEIRCING ❑ POOLISPA ❑ OTHER(Pt EASE SPECIFY ABOV V) <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM <br /> 1!' List up to ten addresses in the space above. Select the type(s)of files from the list above by chEtcking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 464-0138 or mail l'the -' <br /> address inabove. An appointment for review will be con <br /> 2. EHp will nodicatedtify the applicant if any EHD files exist. firmed <br /> approximately five business days but no later than ten (10)days after receipt of application. ul a files <br /> will be held•for a maximum of five business days for review. appointments should be scha<dulecl <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 /> d.by EHD staff at the e a pense; <br /> 4: Any file not returned in the same condition as released will be reorganize <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to rayl®w. <br /> 8. *'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:40 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW <br /> EN 00 14 01109!00 <br />