Laserfiche WebLink
SAN JOAGYdIN COUNTYPUBLIC HEALTH SEP-,�CES <br /> }} ENVIRONMENTAL HEALTH DIVISION <br /> N� 0� 304 EAST WEBER <br /> AVENUE, THIRD FLOOR <br /> STOCICTON CA 95202 / <br /> Iv �\ (209) 468-3420 <br /> _P_UBl(L�IC RECORDS RELEASE APPLICATION_ <br /> APPLICANT Q`A h`"'"\ BUSINESS/AGENCY 9(7-- <br /> ADDRESS CA C�S-'>S— <br /> PHONE_ �,ZZ( FACSIMILE" <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please Ui e 7 t0 10 businessdays from dale or application submittal) <br /> HECK BOX TO,L=XPEDITE REQUEST-$87.00 FEE-RE-QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF 4PPLICANT <br /> DATE <br /> FILE ADDRESS THI5 SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> (o ZS of_c �L_ claw . <br /> IA— <br /> A I <br /> ' 4 �3 S'rflll S IAS . <br /> .d <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ZDERGROUND TANK(UST) CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ).f UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY P01RCING ❑ POOUSPA - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE'FACILITY ❑ PUBLIC WATER SYSTE=M ❑ 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) 464-0138 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. Tile 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 file expense <br /> of the apRlicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. "TENTAT.fVE 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 j YES NO REVIEW DATE <br /> LK 00 14 00/0/100 -- - <br />