Laserfiche WebLink
SAN J+ UIN COUNTYPUBLIC HEALTH S CES <br /> *VIRONMENTAL HEALTH DIVISIV bus <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 f <br /> I (209) 4663420 <br /> l�fh <br /> PUBLIC RECORDS RELEAnSE APPLICATI <br /> APPLICANT d AY11� S BU3INL=SSIAGENCY t�dtYl�I�(� •{ it—r- � 1 C <br /> ADDRESS R37 ;xei) l��{txzd.,�. S'�6kt-6 - ,. '( 9 25' ;2/s ., -.. <br /> PHONE JQCy <br /> TENTATIVE'APPOINTMENT DATE // Q/ TIME ,�•UfJ `^ <br /> (Plaase give 7 to 11/0 bbaVsln Ts <br /> Says from dateoOt 233pllptton sU6miltaq <br /> ACHECK BOX TO EXPEDITE REQUES 78.00 FEE-R/QUEST R�SSEO�' IN 3 6USINESS DAYS <br /> /SIGNATURE OF APPLICANT DATE / <br /> FILE ADDRESS <br /> floe)1/ ;. <br /> IDS <br /> ll° Drr <br /> .. • 35 25' <br /> rt tr t. Ir '35, ry <br /> e <br /> ENVIRONMENTAL HEALTH DIVISION FILES t /I <br /> �l1 UNDERGROUND TANK(UST)CLEANUP SITE ILOP) ❑ HOUSING ABATEMENT ❑ SOUD WASTE FACILITY <br /> F� OTHER CLEANUP SITE(NON-LOM ❑ FOOD FACILITY ❑ Soul]WASTE VEHICLE <br /> UNDERGROUND TANK(UONITORING/REMOVAL) '0 DOG KENNEL ❑ 13AIRY J <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATrOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1, List up to ton 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 mall 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 $78.00 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 /> CONFIRMED APPOINTMENT DATE --- <br /> , TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 0 00 14 PIMMu <br />