Laserfiche WebLink
DATE RECEIVED <br />SAN AQUIN COUNTYPUBLIC HEALT RVICES EH04oGNUMBER <br />ENVIRONMENTAL HEALTH DTVI i N <br />304 EAST WEBER AVENUE, THIRD FLOOR 'n� (�O��D <br />STOCKTON CA 95202 <br />(209) 468-3420 JUL 11200 1 2 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT <br />BUSINESS/AGENCY Vve- —1 1 P s <br />ADDRESS oZ S� % �T GS ru �" t►'G� <br />PHONE (u(911 d-bq - 5c,( <br />FACSIMILE <br />TENTATIVE* APPOINTMENT DATE TIME <br />(Please gl a Z to 1 business gays f date of application submittal) <br />I <br />® CHECK BOX TO EXPEDITE REQUEST - $ 99.00 FEE - EQ ST PRO®S D IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE _ 7 /t —Q -�-- <br />_.FILE ADDRESS. , .Cla sly -4 • <br />111 <br />Tm <br />a <br />�n n ► � r1�ii�T C�11' <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />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 PEIRCING ❑ POOLlSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM '7( OTHER (PLEASE SPECIFY ABOVE) <br />e�.e.< e r? s p <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above b;Il - )Jingo f� <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail 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 $89.00 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. TIME <br />f <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED_ YES NO REVIEW DATE <br />•N 111.11111' <br />