Laserfiche WebLink
03/21/2002 17:25 2094671110 AGE STOCKTON P GE 01/01 <br /> DATE RECEIVED E�V <br /> SAN�AQUIN COUNTYP.UBLIC HEALTH �VICf <br /> ENVIRONMENTAL HEALTH DIVISION <br /> z 304 EASTWEBER AVENUE,THIRD FLOOR W <br /> q. ,a STOCKTON CA 95202 ! <br /> 3 (209)468-3420 " t <br /> PUBLIC RECORDS <br /> RELEASE APPLICATION <br /> APPUCANT Il BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE (dog) y1a iDa6 FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE AMA MA Baal TIME ��`DD MAR 2 1 ZOOZ <br /> T L <br /> (Please gtV,&I 11,biO bus1n ass day hmq1te ofOBU ESS DAYS plioat' n submittal) <br /> CHECK BOX TO EXPEDITE REQUE 8A00�F,E,E�—REQU i5 PRO S D <br /> SIGNATURE OF APPLICANT LV/vi`c DATE a <br /> FILE ADDRE59 <br /> it <br /> 3 - 6 <br /> 5� 5 ad us <br /> 50 <br /> a 57. • <br /> �^MQ IItOt uS2 P MAS � ;I�n9 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT X SOLID WASTE FACILITY <br /> OTH ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK rNERAORING/REMDVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS PWASTE ERMITTED <br /> FACILITY <br /> OR ❑ MOTELIHOTEL ❑ PUMPER TRUGKIYARDICHEM TOILETS <br /> TIERED PERMITYEO FACILITY ❑ POOVSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCING ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <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 1209) 4644)1.38 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 flies <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 /> PATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO . REVIEW DATE <br /> EH go 14 41I09N0 <br />