Laserfiche WebLink
- LFIL3 LUCK NUiLJER <br /> DATE RECEIVED SAN JOAQUIN C DUNTY <br /> r <br /> ,FAD.} ONMENTAL HEAL H DEPAR ENT <br /> EN zR <br /> 'i 304 E Weber Ave 3'd Floor S ckton, CA 95205 <br /> 5 EP 2 4( e` 4.65-3420 Fax: (209) 464-0138 Web: .co.sanjoaquin.ca.us/chd <br /> N\i�IRON►1AFN�f ,9EALTH <br /> PUBLIC RECORDS RELE SE APPLICATION <br /> Ste- BUSINESS/AGENCY: <br /> APPLICANT: <br /> ADDRESS: /jZ'/`0 <br /> PHONE: G .1 Jc�� rZL FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: ID C) Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> Department Use Only <br /> UNIT <br /> �4 FILE ADDRESS <br /> . t: street'Z31 A' 4-1.1-r,t,.'�t T est c N S� Unit i <br /> X12. Sheet <br /> y Lai+�,�-:.. � t Ct .:� e <br /> City ❑ Unit 2. <br /> ,�3. Street <br /> �1 d. Street Cit <br /> COX 3 <br /> 15, Street <br /> Cit <br /> �r 6. SSreel _ <br /> cit Unit 4 <br /> .i 7. Street <br /> Cii <br /> I <br /> B. Street <br /> cly ❑ Unit 5 <br /> E Street <br /> City <br /> Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> r0 HOUSING ABATEMENT EJ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST}CLEANUP SITE(LOP} ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON LOP) CI DOG KENNEL ❑ DAIRY <br /> 'UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> _HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL 13PUMPER TRUCKIYARDICHEM TOILETS <br /> �iIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ 7ATTOOISODY PIERCING ❑ OTHER(PLEASE SPECIFY} <br /> O MEDICAL WASTE FACILITY <br /> I <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 209 464-0138 or mail to the <br /> address indicated above. 1 <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 l <br /> will be held for a maximum of five business-days for review. Appointments should be scheduled <br /> accordingly. 1 <br /> 3. . A file that is actively being worked on by EHD staffmay not be immediately available for review. A new <br /> application may be submitted when the file is avai able. <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 $93.00 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 i <br /> PHONE FAX INITIALS <br /> DATE CONFIRMED <br /> I' <br /> YES NO REVIEW DATE <br /> REVIEWED <br /> l . <br /> Erto 48 02.006 <br /> 8!8!2003 <br />