Laserfiche WebLink
SAN ,}CUil�l �'i�ii�fi 'i'PUSLIC Fii�AL7'ri ria �i , ( L1" °4''l l J` <br /> ENVIRONMENTAL HEALTH DIVISION - <br /> 304 EAST WEBER AVENUE, THIRD FLOOR D�� 14: <br /> �l} <br /> STOCKTON CA 95202 <br /> (2091468-3420 ViR0NiV1Ei%!T i1EALTH <br /> LIG RECORDS RELEASE APPLICATIa I T -,F P,`j^F% � <br /> aPPLIC'.AN BUSINESSIAGENCY C <br /> ADDRESS FT C(J/l a�� Q c � CA/ 5:R S <br /> PHONE rR �& 2:zak FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE 'n ME <br /> {Please give 7 m 10 badness daya from date &applicatlon submittal} L <br /> r-HrZCK BOX TO EXPEorm REQUEST- 71t_4 E—RE ur:$T P;ZOCIwS3ED IN 3 8USIHI=SS DAYS <br /> SIGNATURE OF APPLICANT MJwa�� A 2.9 Q -- - ------ DATE :�f <br /> FILE ADDRESS <br /> �J <br /> �r 2 6 <br /> t <br /> ! 21� <br /> G'r <br /> 3 r <br /> 3S ` • <br /> NVIRONMENTAL HEH DIVISION FILES 1 + I+ <br /> � .� <br /> UNDE�RGeZpUND TANK{UST)CLEANUP 51TE(LOP) ❑ HOUSING ABATEMENT M $OLID WASTE FACILITY <br /> OTHER CLEANUP SrTE(NON-LOP) n FOOD FACILITY 0 SOLID WAsTE VEHICLE <br /> UNDERGROUND TANK(AA40NITORINGJREMOVAL) ❑ DOG KENNEL ID DAIRY tu <br /> 0 RAZARDOUS WASTE GENERATOR 0 CHICKEN,RANCH 0 PPG TREATMENT PLANT <br /> 0 TIERED PERSIMED FACILITY 0 MO7EI.IHOTEL Q PUMPER TRUCKJYARD1CHEMTOILLTS <br /> 1: TATTOO!;';,ODY PERCING 0 POOLISPA 0 LAND tjsE APPLICATION SITES <br /> In MrzDICALwi+STL FACILITY 17 PUBLIC WATERSYST51% In OTHZR(PLLASE SPECIrYAISOVF) <br /> 1. List tip to tart addresses in the space above. SelaCt 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 t4 209 464-01M or mail to the <br /> 40dress indicated_above. <br /> 2. EHD will notify the applicant If any END 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 /> will be held for a maximurn offive 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 avaltable. <br /> 4. Any file not returned In the same conditjon as released will be reorganized by EHO staff at the expense <br /> of the applicant. Future file reviews by the salvo applicant may require a $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must he confirmed with EHO staff. <br /> 6. Applications received after 3,00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWEO YES NO REVIEW DATE <br /> EN 00 14 01J931W <br />