Laserfiche WebLink
DATE RECEIVED tHU LVIi IVUMtftK <br /> w E'E' �/�E LJ40 SAN JoAQtlnt COUNTY <br /> ltZ1 I� ENVIRONMENTAL HEALTH DEPARTMENT 1 "040001 <br /> 304 E Weber Ave P Floor Stockton,CA 95205 <br /> FEB(�O;)2TW 3420 Fax: (209)464-0138 Web:www.co.san-joaquin.caus/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICETUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; .I/1! I /YIRhfkl( BUSINESSIAGENCY: 1 /7 U &71 <br /> ADDRESS: ® S <br /> PHONE: FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS 17 1 r, <br /> SIGNATURE OF APPLICANT2—/ DATE <br /> DeParlmen Use On1Y <br /> FILE ADDRESS UN;Unit <br /> �. s,.., 3 -Fr_ v- ® 1n(�~2. street d d O G _o,✓s. st.eet 3U.3S rt <br /> 4. street 3 -�� Gc <br /> -s, suet 3 Q d Unit 3 <br /> ---6. StIld S qf r-14, A-r fOt,,- otf <br /> -s. Sbeet 1-0 2-3`7 City Unit 4 <br /> 8. sheet `2-$ S Z. oty <br /> -9. sheet i'a ❑ Unit 5 <br /> -10. sbeeet �-�s' City L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ('SOLID WASTE FACILITY `�'t <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ""LL77 SOLID <br /> WASTE VEHICLE�� <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ( DAIRY <br /> ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH KG TREATMENT PLANT L` <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ UMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <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 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 /> 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 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 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 /> CONFIRMED APP®INTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 <br /> 8l8l2003 <br />