Laserfiche WebLink
UA�` Lf iii j EHU LUCK NUMBER <br /> U 11E- �-�'I' �D SAN JOAQuIrr COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> EiC:1 80 2-0 05 304 E Weber. Ave 3`d Floor Stockton, CA, 95205 <br /> : Vi O€��" iJ1(2'i?'�JPB-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin-cams/ehd79 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �C. BUSINESS/AGENCY.--.!VgZ„�.Ll. Y- --La <br /> ADDRESS: 9, d 2- 1 L-CI&IJ <br /> l - <br /> PHONE: 'J U/ f 1 FACSIMILE: 3 LR 5" !i — - <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Phase allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 93.00 FEE— EUUEST PROCESSED IN 3 BUSINESS DAYS _ <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> +. $til �W <br /> 2. Sheer a Cil L <br /> 1. strmq Oty ❑ Unit 2 �� •� <br /> 4. <br /> S1GCf Gl /} � <br /> 5. s� Un3 lP(i7i <br /> G. $ city <br /> ,• sly, :1t <br /> t 4 <br /> a. slffti <br /> 9. Sheaf Cfty A <br /> ❑ Unit 5 <br /> 14. 5:real G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT C1 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL CI DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLAIT <br /> TIERED PERMITTED FACILITY © MOTELtHOTEL Q PUMPER TRUCKIYARD/CHEM TOILETS <br /> Irl TATTOOMOPY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACiLTry ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 249 464-0138 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. 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 EHO 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 $93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3.00 prn will the processed the next business day. RUSI! <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Esso 40-M-00 <br /> orwzao� <br />