Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRoNmENTAL HEALTH DEPA.R:EMENT <br />1 Lt105 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />1 Fr_. __ G, !M)468-3420 Fax. (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />ErdVIRI I � 0HEE-1-1 i VSE <br />PER[,,11T/SERVICES <br />PUJBEXC RECORDS R•UEASE A.:PPUCATI®N <br />APPLICANT. <br />ADDRESS: -t02 <br />SUSiNESS/AGENCY: <br />EPID LOG NUMBER <br />tit- - — ` FACSIMILE: r�`kl t 5( - q2:Z <br />PHONE: ckg 17i3-7 <br />� - <br />TENTATIVE' APPOINTMENT DATE: i :v� 1 _Time: _ <br />(Please allow 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEEt— REQUEST PROCESSED iN 3 BUSINESS DAYS d <br />SIGNATURE OF APPLICANT w p DATE <br />Department Use Only <br />d� <br />ENVIRONMENTAL HEALTH DEPARTMENT FiLES <br />G/UNDi-RGROUND TANK (UST) CLEANUP Si'T'E (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />M�OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY a SOLID WASTE VEHICLE <br />i //UNDERGROUND TANK (MONITORINGfREMOVAL) O DOG KENNEL 0 DAIRY <br />t3AZARDOUS WASTE GENERATOR O CHICKEN RANCH 10 PKG TREATMENT PLANT <br />C,a TIERED PERMiTTED FACILITY ❑ MOTEIJHATEL CI PUMPER TRUCKiYARD/CHEM TOILETS <br />❑ TATTOO/HODY PIERCING Q POOL/SPA 0 LAND USE APPLICATION SITES <br />[D MEDiCAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />11 <br />N, <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 />files exist. An appointment for review will be confirmed <br />2. EHD will notify the applicant if any EHD <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 sante condition as released Will be reorganized by EHD staff at tate expense <br />of the applicant. Future file revievrs by the same applicant may require a $93.00 deposit prior to review. <br />5, *TENTATIVE appointment dates must be confirmed with EHA staff. <br />6. Applications received after 3:00 pm will be processed the next businoss.day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DAT E <br />EHP 4842-406 <br />8/8/20G3 ' <br />