Laserfiche WebLink
SAN JOAQ : CtJUNTYF'Li6L1C HE:AL1'h 6LkV'` c-u V' <br /> EN%v.__JNMENTALHEALTH DIVISION <br /> 3D4 EAST YYEBERAVENUE,THIRD FLOOR JUL 1 8 <br /> STOCKTON CA 95202 20 <br /> (209) ass-sato <br /> PUBLIC RECORDS RELEASE APPLICATIONNVIRONMENT HEALTH <br /> APPLICANT �t/ Q- — - J 4S1N SSlAGENCY 1i(U(1�(IILP �T �? �L,�f�C <br /> ADDRESS IDO 5 <br /> PHONE= ?O -/V FACSIMILE <br /> TE=NTATIVE'APPOINTUENT DATE l �/ TIME j�`L�`�' <br /> (Plea}e Qiv,7 to 10 business days f om date or application sub ttnl) <br /> CHECK BOX TO EXPEDITE REQUE -3 8.00 FEE-REQUEST R ESS D 1N 3 BUSINE55 DAYS f l <br /> SIGNATURE OF APPLICANT BATE l ( J <br /> FILE ADDRESS <br /> • TQC < � I�• <br /> rZ I rr <br /> rt << !` r 1 <br /> `%(Cc <br /> �7 c� L; _ i n .� pl} c <br /> ST!r - <br /> ` "7 r7 a, �' - cr)mit KY r <br /> 2 Lti .tel 1� pq�cuS -��, .VIRaNENTAL HErLTDIViS10 FILES <br /> 1� <br /> 5 ❑ Sol WASTE FA�WtIrly <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT l.� <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY `) <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL D PUMPERTRUCKNARD1CHEh1 TOIL TS <br /> d TATTOO/80DY PEIRCING t] POOLISPA ❑ 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 abovo. 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 209 464-0139 or mail to th <br /> address indicated above. <br /> 2• iHD wilt notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no tater 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 being 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 retumed in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $79.00 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 REV IE DATE <br /> EH DO 14 D110WD4 - <br /> s <br />