Laserfiche WebLink
* TD'BJbd -1ki101 <br /> tnvlNurvhltrvIAL h'tt PACE 0: <br /> SAN JOAQUIN COUNTYPUBLIC: HEALTH SERVICESENVIR <br /> ON <br /> 04 EAST WEBER AVENUE,THIRD NMENTAL HEALTH IF FLOOR <br /> STOCKTON CA 95202 <br /> JAN 1 5 2003 (209) 468-3420 <br /> _ PUBLIC RECORDS RELEASE APPLICATION <br /> bPp � Ir <br /> i <br /> 8l1SINESSIAGEHCY r <br /> ADDRESS <br /> PHONE FACSIMILE ! 1' <br /> ----------------- <br /> TENTATIVE'APPOINTMENT DATE 3 TIME MON(Yl i h ���`� ` 1 <br /> �-t (Plea"give 7 tv 10 buAih2lz��Ys from dale ofapprrcaGon suemlttar) U <br /> u CHECK 90X TO EXPEDITE RE EST.$89.00 FEE EQUEST PROCESSED IN 3 BUSINESS DAY$ <br /> I <br /> -SIGNATURE=OFAPPLICANT DATE 1 ��L� <br /> FILE ADDRESS THIS SIDE EMP STAFF USE ONLY <br /> PROGRAMA ELEMENTS SEARCH <br /> 6 n+P 0A �S <br /> J <br /> N. 5J, ` <br /> `7 l.. U 5 T <br /> 1) � <br /> ENVIRONMENTAL HEALTH DIVISION PILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT CI SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NWI-LOP) C FOOD FACILrTY © SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITOR1NGIREMOVAL) ❑ DOG Ic NNEl, ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHO'rIs'L ' ❑ PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTOO11300Y PEIRCING ❑ POOLISPA ❑ LANt)USE APPLICATION SIT95 <br /> O MEDICAL WASTI;FACILITY Cl PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY AaOV-) <br /> 1. List up to tan addresses in the space above. Select the type(s)of fries from the list above by Checking <br /> the appropriate box(eS). At)east one file type MUST be SeleCted. Pax to (209)464-0138_.gr mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHO tiles exist. An appointment for review will be confirmed <br /> approximately rive business days but no later than tars(10) days atter receipt of application. The files <br /> will be held for a rnaximum 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 relearoad will be reorganized by EHD .Staff at the expense <br /> of the applicant f=uture file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5, "TENTATIVE appointment dates must be confirmed with EHO staff. <br /> S. 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 /> TO/T0'd 82101791760ET 01 8-1 80:21 2002 ST NUf . <br />