Laserfiche WebLink
/ l Y / <br /> r <br /> �xzv <br /> .m • LUQ J SAN Jt7AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> u l ` ENVIRONMENTAL HEAI-TH DIVISION <br /> 304 FAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> P/7USLI IC RECORDS RELEASE APPLICATION y'�7 <br /> APPLICANT- D • )( I A__y V 1 , .� BuSIXESS/AGENCY - L\I•C(t Coe AgateSQ V')U�J'Jssor <br /> ADDRESS <br /> jPNONr 3ro7-Hr I `FACSU E ejC2? <br /> J�� <br /> TENTATIVE"APPOINTMEtIT DATE TIME ' <br /> (Pleaw Siva?tole bV6ln s days from date ofapplisation subm$tai) <br /> �. <br /> y'--' CH CKBQXTG EXPEDITE REQUEST AC PEfw-REQUESY PROCESSED IN]BUSINESS DAYS f <br /> ATURE OF APPLICANT DATE <br /> PILE ADORESS THIS SIDE EHD STAFF USE ONLY <br /> uuncRAM ELSMPNTS SEARCH <br /> AWTM7 <br /> Y1 <br /> ENVIR%ff NME YiLHSALTH DIIV SIGN --ILESI 1 <br /> UNDERP�ROUND TANK(V$T)CLEANUP SifE(LOP) II HOUSING ABATEMENT II SOLID WASTE FAC1LriY - <br /> ((r�`ii6( '•rDt•THER CLEANUP SITE(NON.LOp)t ❑ FOOD FACLLRY E2 SOLID WASTE VEHICLE <br /> UNDERGROUND YANK(MONITOMNil(REMOVAL) 17 DOG KENNEL O DAIRY <br /> A7AFLD0US WASTE GENERATOR 0 CHICKEN RANCH �PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY C1 MOTELn1OTEL n PUMPERTRUCWYARDICHEM-ruji- f8 <br /> TATTOOISODY PEIRCING O POOMPA 4 LAND USE APPLICAMON SITES <br /> MED)CALWASTEFACILITY _ �3lfiL(CWATLRSYSTFM *,G9-pTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(d) of files from the list above by checking <br /> the appropriate box(es): At least one file type MUST be selected_ Fax to (709�464,D138 or mail to thg <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD files e)rist. 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 hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 1 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 fife Is avallable. <br /> 4. Any file not returned in 1:he same condition as released will be reorganized by EHD staff atthe expense <br /> of the applicant Futum file reviews by the same applicant may require a $67.00 deposit prior t0 r$View_ <br /> 5. 'TENTATIVE appointment dates must be confirmed with FHD Staff. <br /> 6. Applications received after 3:00 pm will be processed the next buslness day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 1/1 A IOE7141 a0SSV R U0SJaPUy '0 I !aN HVVt :8 100a '�Si'I;1,p <br />