Laserfiche WebLink
_ I i <br /> 'I [� I <br /> 09/19/2002 16:03 20179-2225 MODE570 ATGQJ <br /> ~ ....... ., PACS P <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES- <br /> ENVIRONMENTAL <br /> ERVICES ENVIRONMENTAL. HEALTH O1VtsiON <br /> 304 EAST WEBER AVENUE,THIRb FLOOR <br /> D <br /> STQfuK'f4N CA Q5202 'I tj <br /> 0* 00 (209)468-3424 <br /> PUBLIC RECORDS RELEASE APPLICATION 19 2092 <br /> APPLICANTt <br /> 8U5INCS5lAGEHCY �7rG X$5c5.rA ENT HEALTH <br /> ADDRESS ///7 4o,ti4_ .ril r� y ) /y1411a?s SIT/SER + <br /> PHONE �� 5" —w'Z.�. FACSIMILE Zb 57-9— e?_?ZS <br /> TENTATIVE'APPOINTM[NY DATE A0,0111140 r TIME <br /> (Please Clive 7 to 10 buzin ..a dayz fro ale at ayj�!' anon 5uEinitl3l) <br /> ID CHECK[i0X T4,EXPE;ITE RCQUCST- �FCE-fC UE RO D IN IIUSINESS BAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> 1 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> hL, U r. <br /> r <br /> 42A RA <br /> I <br /> t <br /> T Z A! I <br /> lMlt p <br /> p ► <br /> ENVIRONMENTAL HEALTH DIVISEON FILES <br /> uNOCAGROUND TANK(Us7)CLEANUP SITE(LOP) Q KOUSING ABATEMENT O SOLID WASTE FAGIUTY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNOEFkGROUNo TANK(MON17TORINGIREMOVAL) 0 DOG KENNEL a DAIRY <br /> hAZARDOVS WA=- GENERATOR O CHICKEN RANCH p 0 PKG TREATMENT PLANT <br /> TIERED PERMIrrED FACILITY 0 P40TEUHt)TEL C1 PUMPER TRVCKJYA9o1CHC-M'FOILETS <br /> R TATTOOIBODY P41RCING O POOL/SPA � Q LAND VSE APPLICATION SITES <br /> O MEOICAL WA5T9 FAciuTY 0 PUBLIC WATER SYSTEMi O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select tho types) of flits from the list above by checking <br /> the apprdpriate box(es). At least one file type MUST be selected. Fax to 1209) 464-0138 or mail to the <br /> address'in_dicated_above. <br /> 2. EHD will notify the applicant if any EHO 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 flit that is actively being worked on by EHD staff may not'lbQ immediately available for review. A new <br /> application may be submitted when tho file is available. It i <br /> 4. Any file not returnad in the same condition as released will Fbe reorganized by EHD staff at the exp=;; <br /> of the appiieant. Futurc file reviews by the same appllcant'ay require a $07.00 deposit prior to review. f <br /> 5. `TENTATIVE appointment dates must be Confirmed with F_HD staff. <br /> 6. Applications received atter 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME i <br /> j <br /> DATE CONFIRMEDPHONF, FAX INITIALS <br /> ,I ---------- <br /> REVIEWt=p YES NO REVIEW DATE i <br />