Laserfiche WebLink
SAN JOS AN COUNTYPUBLIC HEALTH SES 'ICES <br /> e_L-45-o <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PO 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> _ PUBLIC RECORDS RELEASE APPLICATION <br /> _ <br /> APPLICANT 1 J M',J O., ��Vfv�\ BUSINESS/AGENCY 1��-- <br /> ADDRESS «�} ��^1`- —E.��^'� (V�-�C9.DS� r clS�S <br /> PHONE_ 7 ��Z'Z( FACSIMILE' 5�t - <br /> TENTAI I V E"APPOINTMENT DATE" TIME <br /> (Ptc33c eirc 7 from date 10 business clays frodate of application submittal) <br /> .CHECK BOX TO,EXPEDITE REQUEST-$07.00 FEE—REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILL- ADDRLSS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> t C��iv3 �6L� �vti S YG ( O <br /> s <br /> (c,\-\ - <br /> Cn'3 <br /> d 33 S4�1Cn� IAS . — - / w <br /> E13`� 5 F,-e.uno.ti- 5 — NPF _AU29 2001 <br /> Lk 1.1Q 1,4 t=, w%0_'- S( 1 <br /> f/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> %XIU NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ,<1 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> X,f UNDERGROUND TANK(MON ITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERM117CO FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOISODY P14IRCING ❑ POOIJSPA " O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATE=R SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 f2099) 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 expense <br /> of the apRlicant. Futurc file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment datos 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 /> eH oo a aoio7/oo , <br />