Laserfiche WebLink
OCT-19-2084 16:32 H1':ELD ENVIRONMENTAL - 7043946968 P.01/01 <br /> DATE RECEIVED [L <br /> EHQ I.OG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 o <br /> (209)468-3420 Fax: (209)464-0138,Web: www.co.san-ja <br /> oaquin. ,us/ehd� Z 9 2004 <br /> PUBLIC,RECORDS RELEASE APPLICATION <br /> "2 <br /> APPLICANT: 0 1 USINE AGENCY: <br /> ADDRESS; �zlC R �t6 <br /> PHONE: "3 FACSIMILE: d }' A <br /> 4 <br /> TENTATIVE*APPOINTMENT DATE: _ Time: A <br /> (Pleas9 allaw 10 buainmm days from data of application aubml"I) <br /> r!. <br /> CHECK BOX TO EXPEDrrE REQUE1?$ 44 VET R CE58Et]IN 3BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE 0 <br /> Department Use Only <br /> FILE ADDRESS UN17 <br /> Unit 1 <br /> 2 shbet <br /> s Saw ON Cl Unit 2 <br /> �. Slree[ =3 tarty ` f1� <br /> 5. Rrryet C <br /> Unit 4 <br /> B. Spoor CSrr, �,,,,, „••„� - <br /> e. Unit 5 <br /> is speet C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �r0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> tvti� UNhERGROtIND TANK(UST)CLEANUP SETE(LOPS <br /> ❑ OTHER CLEANUP SITE(NON-LOP) C7 FOOD FACILITY M SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL C7 DAIRY <br /> C7 HATARDOU$WASTE GENERATOR M CHICKEN RANCH L7 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY d moTEUiiOTEL PUMPER TRUCK(YARDICHEM TOILETS <br /> C3 TATTOOIBODY PIERCING ❑ POOLfSPA GI LAND USE APPLICATION ams <br /> O MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> 1. List up to ton addresses in the Space above. Select the types)of files from the list;above by checking <br /> the appropriate box(es). At least one fila type MUST be selected. Fax to [209}464-0138 Qr mail to the <br /> address Indicated above. <br /> 2. EH0 will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business slays but no later than ten (10)days after receipt of application. The files <br /> will be held for a nlaxirriurn;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. Anew <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 EHO staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$83.00 deposit prior to review. <br /> S. *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 TIME; � 7 <br /> DATE CONFIRM✓=p "PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 0-n-M <br /> wonec� <br /> s <br /> TOTAL P.01 <br />