Laserfiche WebLink
vncnCI.GIrCU <br /> SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> ENA ONMENTAL HEALTH DEPARTM ,T <br /> �I 370-4 EAST WEBER AVENUE,THIRD FLOOR I <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASEE APPLICATION <br /> APPLICANT BUSINESS/AGENCY I b 7k— EiO Mt�LIC(�f�� �'� <br /> ADDRESS�y r7 p �'/� �— C 4,44— <br /> ( � ,�� �Sg/ 2 <br /> PHONE_ — 1 I(9 /TI y 'fes s� FACSIMILE 3 16 y^�74—O ¢O 4 <br /> A1C.=•° Lu <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> ad U(Please give 7 to 10 business days from date of application submittal) <br /> HECK BOX TO EXPEDITE REQUEST-$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS tw'+ <br /> SIGNATURE OF APPLICANT 1 <br /> DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ,V O Ort—�1}" ING(QIYL v►�UE <br /> MAR I-C L N w E2 <br /> Y a <br /> 20 <br /> PA <br /> / ENVIRONMENTAL HEALTH DIVISION FILES O <br /> ��JNDERGROUND TANK(UST)CLEANUP SITE(LOP) C1HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> r OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> CY}JNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> _WARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 0_PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑,POOUSPA /7 tdLAND USE APPLICjT SITES <br /> ❑ MEDICAL WASTE FACILITY HO OTHER(PLEASE SPECIFY) 11'��,0. , — S'Z/S T S <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 $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 /> 10 Ld <br /> ski r�i <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD 2 <br /> vzsrzDO3000 <br />