Laserfiche WebLink
u� 4VuJlinu/ 17: 1y Q�jIQQI <br /> DATE RECEWEO 1 <br /> EHD LOG.NUMBER <br /> . SAN,.IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone: (209)4683420 Fax: (209)464-0138 Web:www.sjgOv.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: *-� ? eUSrKvSrAGENCY: <br /> ADDRESS: <br /> -� . ./S- j Caylstattkalpp 100 :1) <br /> PHON:(il: r y trram ` GPfS�PACIntEl <br /> Q—Q '' - <br /> TENTATIVE•APPOINTMENT DAM.I",4 P Tinto: <br /> r (ply allow 10 bualnaas days from date ofapplleatlon'submInal."Tantatlrro Only.must bo oant]rtmdi <br /> CHECK BOX TO EXPEDITE REQU .$1105FEC(CASH <br /> +OR CH.ECIK ONLY)-:REQUEST PROCEWED IN s aLISINEn A[Y�S <br /> SIGNATURE OF APPLICANT /,_1-6.L 6.: � <br /> _ DATE �� +9 d <br /> Electronic Information: <br /> I.Ist[]Map—DesGriptian: <br /> FILE ADDRESS EHD USE ONLY <br /> Sersot a sheat Name City <br /> �- _� SII►=)I�i/ 1�d�� aTo/� ❑ !hitt <br /> z <br /> �p 0 unit2 `7 i <br /> 3, <br /> 41, <br /> g, Unit4- <br /> 7. <br /> g. ❑ Unit5 <br /> 10_ ❑ Units <br /> Specific Date Rang@ of Inforeratlon Requested.-From —Z.2 '2. to. <br /> ENVIRONMENTAL HEALTH Or <br /> PARTMEAIT Fli.F.s w ' <br /> UNDERGROUND TANK ) <br /> {LIST}t1LrANunStTx(LOP l�HousINO A9ATEMT?NT 0 SOUd WA-Vt FAaI.ITYIVT HIG f:Z'ic <br /> C1 OTHER CLEANUP S"(NON-LOP) CI FOOD FACILITY 0 WASMI)FIk <br /> Q UNDeROROUN17 TANK(M0NrMRIN%fR9MOVAL) a Doa KEmrm M DAIRY <br /> 0 HAZAR130=WASTE GENERATOR G CNcKEN RANCH 0 WASTEWATERTREATM&CrPLAW , <br /> ©TIERED PERMITTED FACILITY 0 MOTELIHOML ❑Pu6rMkTRUCKIYAWCHkM YalLeM <br /> TATT'OOIBaor PICRCINC E3 POOC4PA fa LAND USE APPUCATION'SnE5 <br /> M M'!WcA4WASTk VAriuTT M OTKtft(PLEASI'.SPECIM <br /> WE4,I,ANDSVTICPERMIT RECORDS AREAVAlLABL4POItRs!wz!w•lW0NOAY-FMVAr8.00AM.3:11erm -ExcLUDINOHOLIDAY6. <br /> I. List up to ten addresses in the 2113ac0 above. 8010ct the types)of files from the list above by checking the appropriate <br /> boAcs). At leant one file type mU$-r be selected. =91 464-01d8 or rna[I to the atldrm%Irrdleeted above, Address y <br /> rsngos will not bo accepted—for additional assistance with Me addroasos,contact tho EHD. Applications received after <br /> 3:00 pm will be processed the next busine"day. <br /> 2 The F_HO will notify the applicant if any EHD files exlat. Art appointment for review will be confirmed approxinmtcly tan(I a) <br /> days after mcolpt of application_ The flies win be hold for a maximum of five business days for review..Appointments <br /> should be scheduled accordingly. <br /> 3. A filo that is actively being worked an by r=Hn staff may not be immediately available for review—A new application may be <br /> submitted when the file is Irvallahl0, <br /> 4. Any fila not returned In the same condition as released will be morganirnd by EHD*toff at the exponso of the applicant: <br /> Futuro iiia review*by tho samo applicant may mquire a$106 d6mmIt prior to review. <br /> EMI?USE ONLY <br /> EHD 48.05 W0419B PUBLIC RECORDS RELEASLAPP FORM <br /> I� <br />