Laserfiche WebLink
r <br /> \ 11/25/2003 16:12 209467 AGE STOCKTON PAGE 01/E <br /> V DATE RE�CEIVEDM � SAN,J YOAQUXN COUNTY EHD LUG NUMBS <br /> ENviRoNmENTAL HEALTH DEPARTMINT <br /> 20 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> NOV 2 <br /> �1 9)468-3420 Fax; (209)464-0138 'Web: www.co.san-joaquin.muslelid <br /> DiVFR;0NMENT HEAL[H <br /> PUBLIC RECORDS RELEASE A]P]PLI®CATION <br /> APPLICANT: BUSINESSIAGENCY- / . &Vk1?Mej1 <br /> iL <br /> ADDRESS: - W)' VQ J�-Oc m <br /> aVp l&�j /U®6PHONE: 'a <br /> FACSIMILE: V <br /> TENTATIVE"APPOINTMENT DATE; TIme- ,° 10 AW led <br /> (Please allow 10 business days from date of application submittal) U `I <br /> CHECK BOX TO EXPEDITE REQU T-$93.00 FELE--RE U T GES IN 3 U INESS DAYS <br /> SIGNATURE OF APPLICANT DATE / �g: <br /> _ Department Use Only <br /> U FILE ADDRESS Z UNIT <br /> 1. Stretl _� G a ❑ <br /> Unit 1 <br /> 2. Street <br /> ? 3. Slut rnb6feCJ y <br /> 4. Street . <br /> Q pn 0 ❑ Unit 2 <br /> e. Street q Unit 3 <br /> 7. Strout ' • t . cityUnit 4 , <br /> 8. Street h Ci <br /> s. stet a <br /> 10, Street El Unit 5 G ', t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES . <br /> UNDERGROUND TANK(UST)CLEANUP SIT>;(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACIA <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL Z DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING . © POOIJSPA ❑ 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 r r iew. <br /> 5. *TENTATIVE appointment dates.must be confirmed with END staff. <br /> 6. t a:', r <br /> Applications received after 3:00 pm will be processed the next business d >a <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX.. 'INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> M003 <br />