Laserfiche WebLink
FRO1 <br /> q,,gnmentaI I FAX NO. 2095690295 - Iec. 29 2005 05 : 48PM P2 <br /> luq�7t�1ir11VIFi' � . L=���Ji <br /> i SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES \ E11O S� NUMBER <br /> [ 005 ENVIRONMENTAL HEALTH DIVISION <br /> , 304 EAST WEBER AVENUE, THIRD FLOOR ' <br /> FI �'uFWAJ` I /'' E /JCFSTI i <br /> ��i� r,;l , -,,,o ( � ��,� G. , STOCKTON CA95zoz <br /> ICS (209) 468-3420 <br /> � <br /> PU13L`IC�J RECORDS RELEASE APPLICATION <br /> ^ <br /> APPLICANT �yf ,ary K ile BUSINESS(AGENCY �'�P 'y G� <br /> ADDRESS ,,,,1 `.� 7 y /7 4/le we 4% R" A,,e,E,, .� "r 1poe <br /> PHONEMIN 42z /J 2 p S <br /> TENTATIVE* APP , /` <br /> TIME / ! <br />' <br /> (Please gIVO Y t0 f811aslnOfrs days from date of application submittal) <br /> FVC <br /> CHECK BOX TO EXPEDITE REQUEST • $89.08 FEE — REQUEST PROCESS E N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT' DATE /� S <br /> FILE ADDRESS - THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ., 3 <br /> .. n <br /> 21 `2 <br /> Age <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT . 0 SOLID WASTE FACILITY <br /> �. THER CLEANUP SITE (NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> Jp UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> rJ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHCM TOILETS <br /> 0 TATTOO/BODY PEIRCING 0 POOLJSPA o LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ton 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. Pax 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 forreview 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 bl ing worked on by END 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 It% the same condition as released will be reorganized by EHD staff at the expense <br /> Of the applicant. Future file reviews i ws b fho same applicant may require a <br /> $89.00 deposit prior to review. <br /> 5. 'TENTATIVE a of <br /> pp ntment dates must be confirmedHD <br /> with E staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE . TIME <br /> DATE CONFIRMED F <br /> I PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> %mr '- <br />