Laserfiche WebLink
06/14/2004 16:13 FAX 209 9480621 Z002 <br /> )A.TE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> In C <br /> 1��1_ •� ;� 0 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EWeber Ave 3'Floor Stockton, CA 95205 <br /> JUN 14 201409) 468-3420 Fax: (209)464-0138 Web: www.co.san_joaquin.ca.us/ehd <br /> ENVIRUNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATIONFth / <br /> r I n v 6 <br /> APPLICANT: -A 0, PCcI(// BUSINESSlAGENCY: <br /> ADDRESS: 0210 S C /-, !� <br /> PHONE: Q 3 FACSIMILE: C;209— / f d & a <br /> TENTATIVE*APPOINTMENT DATE: /l?/0 3 Time: 100 , j <br /> (Please allow 10 business days from date of application submittan <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> DATE <br /> Department Use OnN <br /> �1 2 FILE ADDRESS UNIT <br /> 3 <br /> ❑ Unit 1 <br /> i street 9/q 5 /fell $ a -�-- <br /> ,/V �. s+ a sC Lt R R/ L6 t? U <br /> - — 4. St.ea Ya E PlvSfr{ Lo <br /> ✓ S. su"t pp $ I/icfoJ cityJ Unit 3 <br /> �✓ ✓ s. sem+ .ve La <br /> / s� S U ' Unit 4 <br /> ✓ ✓ S. S. <br /> 9. see (0My ❑ Unit5 <br /> io. so-«caty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT SOLID WASTE FI4CILIIVY`�'-` � <br /> ,f9 OTHER CLEANUP SITE(NON4.OP) ❑ FOOD FACILITY PC SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACKM ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDtCHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING <br /> ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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)464-0138 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 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 returned 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$93.00 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 /> CONF�;ftMED APROINTMENT-DATE `, TIME <br /> DATE CONI=LRMED '.PHONE FAX FNCIIALS N''' <br /> REVIEWED YES . NO REVIEW DATE. <br /> EHD 0-02-001 <br /> N62001 la's •=' "j '` <br />