Laserfiche WebLink
EHD LOG NUMBER <br /> DATE RECEIVED 6 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a� 7 <br /> q 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> SEP 3 0 Z'�209) 46$-3420 Fax: (209) 464-0138 Web:www•co.san-joaquin.ca_us/ehd <br /> Fi��n hLiH <br /> . 'ICES PUBLIC RECORDS RELEASE APPLICATION <br /> ]V <br /> APPLICANT: �'-� t n �"F�^ �"Z BUSINESSIAGENCY: <br /> ADDRESS: ,� NI <br /> PHONE: 1 L c> > FAoCSILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCMSEyf'�1�N�NESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 35 sVee t Q a C �' ❑ Unit 1 <br /> $' stree ci <br /> s a ❑ Unit 2 t1y <br /> 4. Street a <br /> S. stree a Unit 3 <br /> 1 <br /> Ci <br /> 6. SVe Unit 4 <br /> 7. SVeel <br /> Ci <br /> e. steel Unit 5 <br /> Ci ❑ <br /> 9. Street <br /> 10. SUee G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES t <br /> ❑ HOUSING ABATEMENT El SOLID WAS FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> UNDEOTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> OL HAZARDOUS W TANK ENE AORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> $1`.HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> [3TATTOOBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> 13 MEDICAL WASTE FACILITY <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. <br /> 2. EHD 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 /> will 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 /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 11s UP <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 <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD4642-006 <br /> 8 003 <br />