Laserfiche WebLink
I'I 02 / 11 / 03 TUE 14 : 29 FAX 925 253 4985 TREADWELL & ROLLO _ U 001 <br /> cue yer NeMZN <br /> i SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> Fi- 8 1 1 X01) 3 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> UH <br /> STOCKTON CA 95202 151 <br /> (209) assaazo <br /> II " IPU'BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT tlA ird.S BUI 'SINESS/AGENCY _ lyq��,y JQ..U. 4Rp )� l)Q __may <br /> r' ADDRESS .,C.. I L1Ca3Yb qI dre4_.l(ArA , 21 (o nr• rCl f�}l _ 1 <br /> �(- <br /> PHONE . — FACSIMILE 9zs- 2 Se�) — (49 QI_� _ '�_ l <br /> TENTATIVE` APPOINTMENTOATE _ _ I�re'b ZD & a, TIME 00 <br /> (Please give 7 to 10 businoss days from date of application submittal) / <br /> CHECK BOX TO EXPEDITE REQUEST 9,00 F.CE - FEQUEST PROCESSED IN 3 BUSINESS DAYS u f r <br /> 1 <br /> )� SIGNATURE OF APPLICANT ( 4 DATI; 11 <br /> FILE ADDRESS THIS SIDE�EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH - <br /> 41 <br /> MtL <br /> W est -- <br /> 4`30 Yt ac t• �j <br /> 5-74 W 4Csk t a Li -79vvcs� • r 5 /11 �5 -- <br /> 23 5 Tr vat ra /< <br /> i <br /> I _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1$ UNDERGROUND TANK (UST) CLEANUP 517E (LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) . 13 DOG KENNEL ❑ DAIRY <br /> HA4ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH . ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKAYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING O POOLISPA 13LAND USE APPLICATION SITES _ <br /> O MEDICAL WASTE FACILITY M PUBLIC WATER SYSTEM ❑ 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. Fax to (209) 464.0138 or mail to the <br /> address indicated above. <br /> 21 END will notify the applicant If any EHD Nies 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, t <br /> 3. A file thatJ; actively b01ng 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 )h the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future rile reviews by the same applicant may require a $ 89.00 deposit prior to I'evlew. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. 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 /> D <br /> REVIEWEEYES NO REVIEW DATE m r <br /> �n of D <br /> Tn 70j Uf -I u IFl I AI71,INIn1 TAKM RPTMbGb Tb : GIT 7G1R7 /7T. / TT <br />