Laserfiche WebLink
DATE RECEIVED <br /> SANS `.QUIN COUNTYPUBLIC HEALTH ":RVICES EHULUG NUMBER <br /> 'ENVIRONMENTAL HEALTH DIVISlr�N <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> APR n ;1 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Li Iti'v, C,. <br /> APPLICANT eo"c /-j BUSINESSIAGENCY <br /> ADDRESS `'1`1 t UP I <br /> PHONE Zc,-`'1 3 Vel t 3( FACSIMILE ZC'�1 • 7X��1, ��`� Z- <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> ✓/ <br /> El CHECK BOX TO EXPEDITE REQUEST-$89 �F E—REQUEST P O ESSED IN 3 BUSINESS DAYS fill y <br /> � n9 <br /> SIGNATURE OF APPLICANT ` DATE `J <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ct ��( 1, I I(a I�c est• < c(� vC C �{"1 <br /> CD Z Z(') <br /> ENVIRONMENTAL HEALTH DIVISION FILES /1 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE (,fir• �/' <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT SIV, <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA R LAND USE APPLICATION SITES / r <br /> ❑ MEDICAL WASTE FACILITY ❑ C3OTHER(PLEASE SPECIFY ABOVE) q/r <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 expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 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 <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-01.006 -- <br /> ung <br />