Laserfiche WebLink
11 2by-5 Alb -02 2 b i tUiiLS I U A i U rAut �J1 <br />FRO" <br />TO <br />5?9LL25 P• - <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA $6202 <br />(209) 468.3420 <br />PUBLIC RECORDS RELEASE. APPLICATION <br />APPLICANT _Drl_ J ckA t susiNESsrAGENCY Yi� (/y�SyC`C1+sJ' �Vtr_ -- <br />ADDRESS a� ')Q iw�}1yty� S_ - (3 ,o <br />L.'W 4a C4 a S I <br />PHONE Z�)q 5-+-Ct2-221 _ FACSIMiLIE <br />( Q "42, TENTATIVE' APPOINTMENT DATE 4I ,01 TIME},�.�(PI64se give 7 to 10 busirtess days from date of applita60n submltta1) <br />lE CHECK BOX TO PxPEtHTE REQUEST - $78.00 FETE _- REQUEST PROCESSED IN 0 BUSINESS DAYS <br />SiGNATURE OF APPLICANT Q/u� L/� OQQ' -- --- DATE <br />11 <br />ENVIRONMENTAL HEALTH DIVISION FILES �knl-f ' f <br />}3Sj UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />0 HOUSING ABATEMENT <br />O SOLID WASTE FACILITY �� <br />C3OTHER CLEANUP SITE (NON -LOP) <br />0 FOOD FACILITY <br />E7 SOLID WASTE VFJOCLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />o DOG KENNEL <br />O DAIRY <br />d HAZARDOUS WASTE GENERATOR <br />0 CHICKEN RANCH <br />to PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />O MOTEUMOTEL <br />O PUMPER TRUCKtYARDICHEM TOILETS <br />n TATTOOIBODY PEIRCING <br />❑ POOUSPA <br />© LAND USE APPLICATION SITES <br />0 MEDICAL WASTE PACILITY <br />O PURQC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ton addresses in the space above. Select the type(s) of tiles from the list (above by Checking <br />the appropriate box(os). At leastone file type MUST be selected. Fax to (2091 464.0138 gL.MA�t ,shs <br />AfWr42!i Indicxted,r�v_q_ <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 ishould be scheduled <br />accordingly. <br />3. A lite that is actively being worsted 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 %ame condition as released will be reorganized by EHO staff at the expense <br />of the applicant. Future lite reviews by the same applicant may require a $73.04 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 />DAVE CONFIRMED <br />REVIEWED YES NO <br />TIME -� <br />PHONE FAX <br />WHEW DATE <br />INITIALS <br />TOTAL P-02 <br />