Laserfiche WebLink
LHU LUIi NUMbtK <br /> DATE RECEIVED `uI �� SAN JOAQUIN COUNTY <br /> R' )E C E `� E'=J ENVI_;..-AMENTAL HEALTH DEPARTMF—i <br /> F E B &;)20-3420 <br /> 2n 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (4o;) 0-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICETUBLIC RECORDS RELEASE/APPLICATION /l <br /> APPLICANT: .61 .( I BUSINESS/AGENCY: ✓ l ✓1�fll� ado <br /> ADDRESS: Q q:25 S Q -75Cd <br /> -� F7 <br /> PHONE: FACSIMILE: ( ���/ <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 171 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> 1--- �� 'Q�� DATE <br /> Departmen Use Only <br /> FILE ADDRESS T UNIT <br /> 1. Street C C k"3 J v _ — <br /> `�j�, ❑ Unit 1 <br /> 2. Street 36 o G oty <br /> I Streee 3 0 3 S—� G � `j s Unit' �y"�{✓�} <br /> 4. Street 3 '>' 3 <br /> Ci �n e, <br /> S. street Q C" ty Unit 3 <br /> a�15C <br /> e. street S 4 r-i4 �r G ;!��elxo� <br /> 7. Street 7-2 2-3-7 o vWU . <br /> a. street Z S Scity <br /> 9. Street `t a a JC, ❑ Unit 5 <br /> 10. Street �.�- �- oty <T"1C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ttNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT [t,�SOLID WASTE FACILITY <br /> ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> ERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL AIRY <br /> ARDOUS <br /> WASTE GENERATOR ❑ CHICKEN RANCH 7 U-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ UMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)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 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$93.00 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 APPOINTM ENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHo 48-02-006 - <br /> uannn <br />