Laserfiche WebLink
Ir <br /> 11- 1L7-2000 04 : 34Pi`I Fti 'fU 19168610430 P . Ol <br /> k _ SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES � W LVG NUMLLfl <br /> ENVIRONMENTAL HEALTH DIVISION ✓ I <br /> 304 EAST WESER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468'-3420 <br /> IPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> n 1� 11 BUSINESSlAGENCY aK <br /> .t� t[y <br /> r ADDRESS 9 L <br /> PHONi YiK�__ �- P77AC__SIMILE <br /> TENTATIVEkAPPOINTMENTDATE / �I'1 � � � ` }�me D aYYI77 <br /> IPleaso give 7 to 10 days fr= date of appllption v> ittal) <br /> CHECK BOX TO EXPEDITE REQUEST S37,00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS _ <br /> SIGNATURE OF APPLICAN� l� DATEJ�I ( f <br /> FILE ADDRESS iN15 SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> & dK _ <br /> . . a ( K <br /> Inn 35. 2(. <br /> c35 • a7 <br /> Y 35 � S' ,v..�, •t <br /> o35a-G rn,� - I <br /> ENVIRONMENTAL HEALTH DIVISION FILES (kvl <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ADATEIatENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE INON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMnI FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCKlYARD1CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ P601JSPA ' ❑ 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 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) 464-9738 ar maif to the <br /> address indicated above_ _ <br /> 2. EHD will notify the applicant if any END 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 $87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received atter 3:00 pm will be processed the next business day. <br /> i <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />