Laserfiche WebLink
6-18-2089 09 169(1 FRO <br /> TQ 1916921 P.e2 <br /> .C4�NL'U tr QUA.NUNL*lt <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES 1� <br /> 5 -ENVIRONMENTAL HEALTH DIVISION l�}- <br /> 304 EAST WESERAVi:NUE,THIRD FLOOR ` <br /> STOCKTON CA 95202 <br /> (203)468�3420 <br /> PUBLiC RECORDS RELEASE APPLICATION <br /> APPLICANT� -�r`� Lt• DOSiNESSIAGENCY. ---- <br /> ADL)RrCSS�i � p <br /> PHONE I 'i 9 -l�j)FACSAAIL€ IqaL L3 Ct I ip <br /> TENTATIVE*APPOINTMENT DATE U �� TIME t <br /> (Meas*give 7 to 40, ners days from date of application S&NIMMuall <br /> Q CHECK BOX TO EXPEDITE REQUEST-$7 40 FEE-REQUEST PRocESSEiD IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �� U <br /> FILE ADORE-5S TH(S SIDE EMU STAFF 135E ONLY � <br /> PROGRAM CLEMENTS SC ARC14 <br /> I <br /> 7 <br /> ` I <br /> 1 - <br /> 1 � I <br /> E 1 <br /> V <br /> ENVIRONMENTAL"HEALTH DIVISION FRES <br /> UNDERGROUND TANK LUST)CLEANUP SfrE(LAP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY C3 SCUD WASTE1f7EHICLE <br /> UNDERGROUND TANK[M0NIT4DRkR%REMGVAL) ❑ DOG KENNEL LI DA97V <br /> HAZARD005 WASTE GENERATOR d CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY , 0 MOTMJHOTEL 0 PUMPER TfRUCKFYARDICFfJXTOILETS <br /> O TATTGOISODY PEiRCiNG ❑ POOLISPA Q LAND USE APPLICATION SITES <br /> LI MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM I� OTIJER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tern 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 fife type WAIST be selected. Fax to (209)464-0138 or mail to the <br /> add s Ind g t v _ <br /> 2- F-HO will notify the appilicant if any F_HD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than text(10)days after receipt of apAficatlan. Tits 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 notbe 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 EHn staff at the expense ' <br /> of the applicant:Future fl[e reviews by the same applicant may require a$79-OD deposit prior to review. <br /> 5. ''TENTATIVE appointment slates must be confirmed with EFID staff, <br /> 6. App]ications recelved after 3.00 p+n will ba processed the next business day. <br /> [CC)NFIRMED APPOINTMENT DATE 37ME <br /> ©ATE CONFIRMED PRONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EM ao 14 NRUM -- <br /> TOTRL P.132 <br />