Laserfiche WebLink
Dec 08 04 02: 37p Hanover Inc 530 342 14904 p. 2 <br /> EHD LOG NUMBER R <br /> KA <br /> I���'i �`�� .� J0�IQUIN COUNTYPUBLIC HEALTH SER%i _S ' <br /> L' , L ENVIRONMENTAL HEALTH DIVISION <br /> D E c $ 2004 304 EAST WE13r=R <br /> AVENUE THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ,_ 'TH (209)468-3420 <br /> lr, UBLIC RECORDS RELEASE APPLICATION <br /> APPOCANT_L nz� _B 1Q BUs1NESS/AGENCY_ +��0VAC-t� h1/1 Y�t�rn <br /> ADDRESS iQ�? h't aI-C,kAdy,Er S?, s'L' Ir <br /> PHONE FACSIMILE <br /> I: 3� <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.;87.00 FEE-.REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> f �: • p DATE <br /> FILE ADDRESS IS SIDE EHD STAFF USE ONLY <br /> ROG ELEMENTS <br /> hoz til. An+e_ros ►`I )i= <br /> S 2? tA. i i 1 _r4- U�St ",J <br /> on <br /> �r�vn <br /> 21c3t7 1 <br /> Ul_S T- sift <br /> W 9 �. <br /> �q�41 E=rc,n-gin$ ��. t1ST <br /> fir. <br /> • i <br /> ENVIRONMENTAL HEALTH DIVISION FILES 1, <br /> dUNDERGROUND TAMC(UST)CLEAN <br /> SITE(LOP) 0 HOUSING ABATEMENT [3 SOLID WASTE FACILITY <br /> /OTHER CLEANUP SITE(NON-LOP) 10 FOOD FACILITY Q SOLID WASTE VEHICLE <br /> C UNDERGROUND YANK(IMONrrORJNG/REMOVAL) ❑ DOG KEN NFL a DAIRY <br /> 1�HAzARDOUs WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT j*%S$ <br /> C3 TIERED PERMITTED FACILITY O MOTEUHOTEL Co PUMPER TRUCK/YARD/CHEM TOILETS <br /> b TATTO018ODY PEIRCING ❑ PCOL/SPA " ' ❑ LAND USE,APPLICATION srfEs <br /> ❑ ME:?ICAL WASTE FACILITY '© PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 7. List up to ten addresses in the space above. Select the type(s)of files from the list above by checkin t <br /> the appropriate box(es). At least one file type MUST be selected. Fax to{2Q9)4§4.0138 or mail to the 1 <br /> ;address indicated above. <br /> 2. FHD 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 /> wil(be held for a maximum of five business days for review. Appointments should be scheduled <br /> ac0rdingly. <br /> 3. A file,that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> applivgtion 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. Applicatic 7s received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APP0110TMENT BATE TIME <br /> DATE CONFIRMED PHONE FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH DO 14 GZM7195 <br /> TOTPL P.01... <br />