Laserfiche WebLink
I �I <br /> SAN JOAN COUNTYPUBLIC HEALTH SEES ...... <br /> ...ES — <br /> ENVIRONMENTAL HEALTH DIVISION <br /> \� < 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 7 STOCKTON CA 95202 <br /> PO �\ �' (209) 460-3420 . <br /> _PUBLIC RECORDS RELEASE APPLICATION <br /> _____ <br /> APPLICANT IJ Qv` f'�'`""�\ OUSINESSIAGENCY <br /> ADDRESS <br /> rr ��� ' \—��v�n M_pc9.LS�c (A <br /> PHONE FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Plca:e 0iy c 71. 10 business days from dale or application submiaal) <br /> C.fIv�TS 3, SL <br /> CHECK BOX TO,EXPEDITE REQUEST-$07.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE:ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> (o Z5 SEC .L_ tAw . <br /> �n33 '-L <br /> IE <br /> ) <br /> .d <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE- FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> )Kf UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOU5 WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY P14IRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE= FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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) 464-0130 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 ton (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 now <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 file expense <br /> of the apRlicant. Futuro file reviews by the same applicant may require a$07.00 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 /> 0 oo 14 oawrco <br />