Laserfiche WebLink
SAN J'AQUIN COUNTYPUBLIC HEALTH St=4VICES <br /> � NVIRONMENTAL HEALTH DIVISit.. <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 35202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION 1 <br /> 41 <br /> APPLICANT fJ LJe,,,�& BUSINESSIAGENCY ,LQ,ddeiMed y&01!^D M[_ <br /> ADDRESS /- • (.(JI L -1 0 CA �-7 so;fOS— <br /> PHONE FACSIMILE PC / �p <br /> TENTATIVE"APPOINTMENT OATEl"V G- f2 a a' TIME 9Q.00 A<2P%' <br /> (Please give 7 IG 10 bmindss days from date of application submittal) <br /> '�i CHECK BDXTO EXPEDITE REQUEST-S - FE —ft EST PROCESSED IN a BUSINESS DAYS iP����' <br /> SIGNATURE OF OF APPLICANT 25 2A DATE <br /> FILE ADDRESS , <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> B( UNDERGROUND TANK(UST)CLEANUP SITE(LOPI ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> §OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ $OLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 indicatest above_ <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review Willi 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 an 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 sante applicant may require a$76.00 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 /> EH 00 14 avo&aa <br />