Laserfiche WebLink
Dec 08 04 02: 37p Harover Inc 530 X42 1490, p- 2 <br /> r1TU t-GYJti� �c.IG•.rani . .,v., <br /> QAT6 RF EHD U> NUMBER <br /> -NIL,i '"VtF .lOAQUIN COUNTYPUBLIC HEALTH SERVIL:ES � <br /> ��' J' C~� J - ENVIRONMENTAL HEALTH DIVISION <br /> D E C $ 2004 344 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95242 �. <br /> J {209}488-3420 <br /> BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �7 hz 16t C, BUSINESSJAGENCY 0-r-,0Ye'e Mel* <br /> ADDRESS r <br /> PHONE 3 <br /> FACSIMILE <br /> 12 a�' r0� TIME I• 3� <br /> TENTATIVE`'APPOINTMENT DATE� - <br /> (Please give 7 to 10 business days from date of applicetiai+submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$81.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> . ?7Z taATE <br /> SIGNATURE OF APPLICANT rr.��`, <br /> FILE ADDRESS IS SIDE EHD STAFF USE ONLY <br /> ROG ELEMENTS <br /> �{oz !J• An+e_ros N )r <br /> 21c30 �rc.rnon S� f <br /> �=s c C:.- Vit,?.Y.- •' lr;". l�ST �� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> d OTHER CLEANUP SITE(NON-LOP) n FOOD FACILITY D SOLID WASTE VEHICLE <br /> CEJ/UNDERGROUND YANK(MONITORINWREMOVAL) ❑ DOG KENNET. ❑ DAIRY <br /> fl HAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH ❑ PKO TREATMCKI ARD/C PLANT <br /> C3 TIERED PBRMiTTED FACILITY D OIL"MOTELIHOTEL O PUMPER TRUCK/YARD/CHEM TTS . <br /> d TATTOO/BOOY PEIRCING ❑ POOVSPA "' C7 LAND USE APPLICATION SCFE$ <br /> D OTHER(PLEASE SPECIFY ABOVE) <br /> C3 MEDICAL WASTE FACILITY '0 PUBLIC WATER SYSTEM <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checkin, <br /> the appropriate box(es). At least one file type MUST be selected. Fax to( 09)4fi4-0138 or mail to the <br /> address indicated above. <br /> 2. .0,415 will notify the applicant if any EHD files exist. An appointment for review will be confrn►ed <br /> approximately five business days but no later than ten (1o)days after receipt of application. The files <br /> wil�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 /> applic9tion may be submitted when the file is available. <br /> 4. Any fiw 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$87.00 deposit prior to review. <br /> S. "TENTA'i,IVE appointment dates must be confirmed with EHD staff. <br /> a. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOIIiiTMENT DATE TIME <br /> DATE CONFIRMED _-- PHONE FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> W 00 '14 OM7/pu <br /> TOTRL P.01... <br />