Laserfiche WebLink
SAN JOAQUIN COUNTYPUBLIC HEALTH StKviCtbhk( ;d j D <br /> - 4 ARONMENTAL HEALTH DIVISIOI` 1% <br /> VA AST WEBERAVENUE,THIRD FLOOR"/ JUL 1 8 <br /> STOCKTON CA 95202 <br /> (209)468.3420 NVIRONMENT HEALTH <br /> PUBLIC RECORDS RELEASE++APPLICATION <br /> APPLICANT f l / . f S �ISINESSIAGENCY (IA2?l 19 U1 <br /> AA <br /> ADDRESS -7^ o s /Il• LC/l� ( S Q C �j etq SOz�pS� - <br /> PHONE RI� Z1112-IIID FACSIMILE O( '7 //V <br /> t <br /> TENTATIVE'APPOINTMENT GATE /H/ 1 W10 <br /> O TIME <br /> (Please giea 7 to 10 business days fl m date Of OPPliaation sub Nal) UL 18 <br /> nn�n <br /> CHECK BOX TO EXPEDITE REQUE -S 8.00 FEE-REQUEST R CESS DIN 3 BUSINESS DAYS 17 J�y <br /> SIGNATURE OF APPLICANT lid DATE ! / <br /> FILE ADDRESS <br /> D S r e <br /> tI rr 2 � <br /> rt fr ig ce �. <br /> r) Ali 11 s f7 <br /> s7rl <br /> 5 p 1t1 0 tnP�( c <br /> MENTAL HEALTH DIVISION FILES " 1 a tOy <br /> vow UNDERGROUND TANK(UST)CLEANUP S17E(LOP) d HOUSING ARA y �/7�(� 0 WASTE FA O <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACIL.n'1(("I(Ill �/ IIU111 WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL I�(Jj]UILIIWl I1L1�IL1�7 a <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANC ATMFNT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL JUL 2 0 0 CARD USE APPLICATION SITEPUMPERTRUCKfYARD EM S 79 <br /> ❑ TAtTOOIBODY PEIRCING t] POOUSPA <br /> MI MEDICAL WASTE FACILITY 13O PusbC WATER SYSTEM OTHER(PLEASE SPECIFY ABDYE <br /> 1• List up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0136 or mail to the <br /> address indicated above. <br /> 2. END 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 $78.00 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 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> x oo a ovovoo <br /> -; �� :� TT" <br />