Laserfiche WebLink
V ...VJT6.:..i++ I::11V LVV lYV4V101�1� <br /> r+a�r rrr•L I\/F11 sti <br /> SANG' QUIN COUNTY ; <br /> ENVjJZO&M,'NTAL 11EALT11 DEPARTMENT <br /> 304 B Weber Avc 3r1 Floor Stockton,CA 95205 <br /> <<w1 68-3420 Fax: (209)464-0138 Web:www.co.san-Joaqwrica.,us/chd <br /> RECORDS RELEASE APPLICATION <br /> ;APPLICANT:_ ZA CX eWINESSIAGENCY: 66d. <br /> ADDRESS: zedezL RL3 a IP 9 3 7d <br /> PHONE: 202. %J!k Q FACSIWLE: -d d 7 <br /> TE PpINTMENT DATE: ASAI' Time: <br /> '���' (Please allow 10 business days from date of application submittals - <br /> CEG BOX TO EXPEDITE REQUEST-$03.00 FEE-REQUE$T PROCESS FM IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE id ��y <br /> Department Use Ont <br /> FILE ADDRESS UNIT <br /> 79 E city / Unit 1 ff// <br /> t. sir <br /> GAP n 5 <br /> s 1=00AIS 9� 5�& / Unit 2 <br /> 0 <br /> S. sacs d can OG`«[9N / Unit 3 <br /> s. � d0 O 1+CZdi✓ <br /> 7. 51reet <br /> Unit 4 <br /> a Bar« c <br /> 9- Barret f �U� <br /> ;+r <br /> ho. ave>rl <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(U57)CLEANUP SITE(LOP) HOUSING ABATEMENT Aa-�OLID WASTE..-.�.�... <br /> OTHER CLEANUP SITE(NON-LOP) ,FOOD FACILITY SOLO WASTE VEHICLE <br /> UNDERGROUND TANK(MONrroPJNGIREMOVAL) <br /> OG KENNEL DAIRY TREATMENT <br /> PLANT <br /> OUS WASTE GENERATOR -CHICKEN RANCH / UMPETRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITYyIOTE1JFiOTEL <br /> o TATTOOISODYPIERCING POOWSPA l,ANDUSE APPLICATION SITES <br /> ,Ile m icAL WASTE FACILITY O OTHER(PLEASE SPECIFY} <br /> 1. List up to ten addresses In the space abova. 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(2091464-0138 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. Anew <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 bythe Baine applicant may require a$93.00 deposit prior to review. <br /> 6. *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 REVIEW DATE <br /> EH0.18-02-0DS <br /> lh/7o6] <br />