Laserfiche WebLink
;ATE,R ';rEIVEF) <br /> EHD LOG N(JMDER <br /> SAN JOAQUIN COUN-ry to <br /> E NVIRONMENTALREALTH DEPARTMENT <br /> 304 E Weber Ave P Floor Stockton, CA 95205 <br /> fii ") so <br /> '/�N9) 468-3420 Fax: (209) 464-0138 Web: vAvw.co.,_ <br /> all-joaquin.ca.us/elad <br /> 10 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT, <br /> BUSINESSIAGENCY: /AV/ <br /> ADDRESS, S <br /> PHONE Lk-4 3—Iro I -� <br /> FACSIMILE; <br /> TENTATIVE*APPOINTMENT DATE: Time, <br /> ('lease allow 10 business days from dale of application submfttal) <br /> CHECK BOX TO EXPEDITE REQUEST $93-00 FEE QUEST PROCESSED IN I BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> C)OPutment Use Only <br /> FILE ADDRESS UNIT <br /> 1. S111111 _3z _� F_ Weltk6ti4cA_ P-.O(. cityl <br /> 2. Shl.rl 3i-(o Q Cit Unit I <br /> f_jF�v <br /> L _ 1Q � _ EUnit 2V <br /> 5' <br /> e C-7i ("lly <br /> 6 slrttf Unit 3 <br /> iA 01 <br /> 7, Atree[ LtOL(,2_.._� . ( <br /> 8. s milC11y A-), F� Unit 4 <br /> tt C11 <br /> E71 Unit 5 <br /> Cit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT EI 801-10 WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY El SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL El DAIRY <br /> V HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY M MOTEUHOTEL 0 PUMPER TRUCKIYAREVCHEM TOILETS <br /> TAT70018ODY PIERCING U POOLISPA In LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List lip 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 notifytheif 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 depo-sit,prior to review, <br /> 5. *TENTATIVE appointment dates must be confirmed with F-Ho staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMD APPOINTMENT'DATE TIME <br /> DATE CONFIRMED PHONE <br /> FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ­EHD 40-02ZU'r <br /> W012003 <br />