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DATEREC&VED APPLICANT PHONE SAN JOA( 'N COUNTYPUBLIC HEALTH SER :ES E1 ViRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (209)468-3420 PUBLIC RECORDS RELEASE APPLICATION `fUUb _FACSIMILE EH WGIMMaRR oo-o��' ANR 112000 r-NV1R0NTMJJ _ EEAUFH at i:P%11'-:'SERVICES TENTATIVE' APPOINTMENT DATE TIME �J (Please give T tD 10 business days from dale of application subml-tial) I �' FIECK BOX TO EXPEDITE REQU $79.00 FEE - REQUEST CESSED M 3 BUSINESS DAYS / 7 SIGNATURE OF APPLICANT_ r� DATE List up to ten addresses In the space above. Select the types) of files from the fist above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0136 or mail to the MIM indicated above. 2_ EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly, 3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new application may be submitted when the file Is avaliabla. 4- Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3.00 pm will be processed the next business day. —� CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS NO REVIEW DATE CII APR 13 2000 r ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK JUST) CLEANUP 51YE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY ❑ SOLID WASTE VEHICLE ^ OTHER CLEANUP SITE (NON -LOP) UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DOG KENNEL ❑ DAIRY ❑ PKG TREATMENT PLANT tel/ (�(\ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS W ❑ TIERED PERMr"ED FACILITY ❑ POOLISPA Cl LAND USE APPLICATION SITES • TATTOOIBODY FORCING ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) ❑ MEDICAL WASTE FACILITY List up to ten addresses In the space above. Select the types) of files from the fist above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0136 or mail to the MIM indicated above. 2_ EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly, 3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new application may be submitted when the file Is avaliabla. 4- Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3.00 pm will be processed the next business day. —� CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS NO REVIEW DATE