Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY - <br /> �� I��`=)1 ENV TiL20NMENTAL HEALTH DEPART`,ffENT <br /> SEP 1 2 20 304 E Weber Ave P Floor Stockton, CA 95205 <br /> �09)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> -i,mkjf&1ENT HEALTkl <br /> DERiOIT/SERVICES PUBLIC RECORDS RELEASE APPLICATIONIr �/ r <br /> APPLICANT: 5; -4 e O 0�{ _BUSINESS/AGENCY: C0,1 C� G <br /> ADDRESS: �lwu.+ �� S r 6 r.95T_��I C <br /> PHONE: 2 4 1 Z3 i Q J� FACSIMILE: 2-0 9 Z- <br /> 3 <br /> .jtaa3 <br /> TENTATIVE'APPOINTMENT DATE: \A/,� � � <br /> T_ �O Time: <br /> (Please allow 10 business days froth date.of application submittal) <br /> 0 CHECK BOX TO EXPEDITE.REQUEST- 93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� <br /> Department Use Only <br /> ,. <br /> FILE ADDRESS UNIT <br /> x <br /> 1. <br /> street 2-5-7 5 C t. ( k ..City.. 1a _ _.. ._. <br /> ' <br /> .G _ . . . <br /> Unit 1. <br /> 3. Street 7i7 City......... L <br /> ❑ Unit 2 <br /> 4. Streel <br /> /7city °r G lr <br /> S. Street lS <br /> 2 Z - <br /> 6. StreetCity., .. . . <br /> � <br /> 7. Street 2' 1 n' Ci Unit 4 <br /> . i ��. <br /> 8. Streetcity <br /> 9. Street Unit 5 <br /> .. ..r. , <br /> 10. Street &' <br /> Zf <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ,d HOUSING ABATEMENT ❑ SOLD)WI ASTE FACILITY,!, <br /> �WVnTHER CLEANUP SITE(NON-LOP) "" -❑ FOOD FACILITY-" -'-D SOLID-WASTE VEHICLE' <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL.7 .4 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE.SPECIFY) <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.day_s for review.' Appointments.should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may notbe 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*releaed!swill be reorgaf ii'ed t y:EHIJ'staff at the expense <br /> of the applicant... Future file reviews by the same-applicant may require.a X93.00 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. > - i? ' <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX.'. : : INITIALS <br /> REVIEWED YES NO REVIEW DATE, . <br /> EHD 4"2-006 <br /> x1=003 : /j'),j, Z� f �'n q i s • s , o r T4_ <br />