Laserfiche WebLink
EHD LOG NUMBER <br /> ( <br /> DATERECEIVED (� SAN JOAQUIN COUNTY <br /> PH E,`��FiI1 U E U ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 3 0 2004 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PEW01T/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ON C1r ES BUSINESSIAGENCY: C�F�/1�t<y el_�701V1 etz 7-16 1, <br /> ADDRESS: P d B OX 3 71 A,1-0 CIC CQ3-0 <br /> PHONE: la - 1 40 � Z s <br /> 3 FACSIMILE: O fU — /g Z/ <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> 6 <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$9 FEE—R ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> ,. Street 1606j5 ROAD G S-roG AI ❑ Unit 1 <br /> 2. Street n/E 0 G -f o d, <br /> 3. Street O X Unit 2 -I <br /> 4. Street p � <br /> 5. Street <br /> a Unit � <br /> 6. Street C' <br /> 7. street city Unit 4 <br /> 8. Street city <br /> 9. Street G ❑ Unit 5 <br /> W. Street G <br /> ty <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> B/ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> F3-OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(M ONITORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IP,HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILfTY ❑ MOTELIHOTEL ❑ UMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA V ELAND 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 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$93.00 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 APPOINTMEt4T DATE . <br /> .TIME <br /> DATA CONFIRMED ~"PHONE FAX IN171ALS <br /> REVIEW DATE <br /> REVIEWED YES NO <br /> ENO 48-02-006 <br />