Laserfiche WebLink
10/04/2002 11:12 209-579-2225 �10DESTO ATC PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR0 *ZO /O <br /> STOCKTON CA 95202 <br /> 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESS/AGENCY TG <br /> �t J <br /> ADDRESSI11 La,Q P (w, C i�G Mo�C T� C� <br /> PHONE Oq S9- 2221 �2Q� S�j-�?ZS <br /> FACySIMtLI <br /> TENTATIVE'APPOINTMCNT DATE fU -'ZI " UZTIME TH <br /> (Please Oi e 7 la 10 bu;incss ays Jr dal#01PI31i calon sum�lal) PERMIT/SERVICES <br /> CHECK BOX TO,EXPEDITE REQUEST-*0 FCE-RCQ ST Pt�SJ BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> r DATE 2— <br /> FILL: <br /> FILE ADDRESS THIS SIDE EHD STAFFU— SLf ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> o, Gvicer <br /> J!56S i7e v1 G:d S. Esc t v, <br /> c F„r�.s S�Sg SGcf oAve— S ,k <br /> B t S.6S A Se i 2,353 <br /> Se Ce, •✓ <br /> !i;40 Tri (;1,40 To,me ' <br /> jklcl "H.,I Ivnv{' 235tVa5 H R 7✓a <br /> f2 �rq< <br /> �M 3 350 Tr.,c ajyj S. T✓A <br /> Tr Ivv c 2,¢S N we ✓.S. T►-wc <br /> a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING A13ATEMEN7 d SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ <br /> X UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL SOLID WASTE VEHICLE <br /> 0 HAZARDOUS WASTE'GENERATOR O DAIRY <br /> ❑ CHICKEN RANCH O pKG TREATMENT PLANT <br /> ❑ TIERED 113ODY T 1 FACILITY O fAOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOL VVA5 Ps rACI I ❑ POOUSPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WA5 rL FACILITY ❑ PUBLIC WATER SYSTEM O OTHER(PLEASC SPECIFY ABOVE) <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(cs). 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 tite expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 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 APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX <br /> INITIALS _ <br /> REVIEWED YES NO <br /> �M oo �� uofroo REVIEW DATE <br /> n <br />