Laserfiche WebLink
SAN ... eAAST OUNITYPUBLIC HEALTH Ser <br /> _ <br /> VtRONM NTAI HEALTH p YISI <br /> 304 ESER [Cl 00/056 <br /> AVENUE,THIRD FLOOR <br /> a STOCKTON CA 95202 <br /> `� ,, ,t�( (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT IO44 C.IS Ke rpS HUSWESSIAGENCY ii�Jl n n'I[°✓Ul� C�.tSU r. <br /> ADDRESS, <br /> �t <br /> PNONF L PACSIMILF Scb� � 7D - ZS-[b .I�• _ <br /> 7ENTATIVE"APPOINTMENT DATE <br /> --31-1 1 TIME � A 1 <br /> (Pis=s girc 110 to aualnSss days tram Ilatr�of appllcatim is —um <br /> CHECK BOX TO EXPEDITE REQUEST S71Lea FEE-REQUEST PROCESSED IN 5BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �JLLj DATE 100 <br /> FILE ADDRESS <br /> ti.<kJIS <br /> V5r - - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> fUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LAP) 0 FOOD FACILITY D SOLID WASTE VEHICLE <br /> UNOERGROIfND TANK XONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH CI PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL O PUWWR TRUCKIYARnICHFAI TOILETS <br /> CT TATTOQBODy PEIRCING O POOUSPA 13 LAND USE APPLICATION SaIES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 13 OMER(PLEASE SPECIFY AROVF) <br /> 1• List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate r)OX(es). At least one file type MUST be selected. Fax to(209)464-0139 or mail to the <br /> acldrass indir.Ated Above. <br /> 2. END will notify the applicant if any EHf)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 ma)dmum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by FHD staff may not be immediately available for review. A new <br /> application may be submitted when the file IS available. <br /> 4. Any Fie not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a E76.00 deposit prior to review. <br /> 5. "TENTAT[V,E appointment dates must be confirmed with END staff. <br /> & Applications received after 3-00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _, PHONE FAX JNITUttS T <br /> REVIEWFO YES NO REVIE=W DATE <br /> 64 W 14 vlffl� <br /> TOTRL P.02 <br />