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DATE RECLVED APPLICANT ADURESS SAN JOAC& COUNTYPUBLIC HEALTH SER*S EN ONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (209)468-3420 PUBLIC RECORDS RELEASE APPLICATION EHD L0(3-jv aB 00-0�� ANR 112000 INVI(oPJM_r.T --AL FH 'F.j,M 'SI-RV/ICES TENTATIVE' APPOINTMENT DATE TIME (Please give 7 to 10 business days from data of appllcatlon submittal) ' 'NEGK BOX TO EXPEDITE REQUE $7e.DO FEE — REQUEST ESS�E/D IN 3 BUSINESS DAYS jSIGNATURE OF APPLICANT_ GL�L�C"-Q-'Iti(�-1 'f 'S� DATE _ ENVIRONMENTAL HEALTH DIVISION FILES An I d 2000 UNDERGROUND TANK (UST) CLEANUP SI rE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE UNDERGROUND TANK (MONITORING)REMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIEREO PERMITTED PACIUTY ❑ MOTEUHOTEL ❑ PUMPER TRUGKIYARDICHEM TOILETS ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL, WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) m,. 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0136 or mail to the address 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 EHD staff may not be immediately available for review. A new application may be submitted when the file Is available - 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 DATE CONFIRMED TIME PHONE FAX REVIEWED YES NO REVIEW DATE INITIALS -�I+n• entiir�i��-�1r1Ln7 ENVIRONMENTAL HEALTH DIVISION FILES An I d 2000 UNDERGROUND TANK (UST) CLEANUP SI rE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE UNDERGROUND TANK (MONITORING)REMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIEREO PERMITTED PACIUTY ❑ MOTEUHOTEL ❑ PUMPER TRUGKIYARDICHEM TOILETS ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL, WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) m,. 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0136 or mail to the address 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 EHD staff may not be immediately available for review. A new application may be submitted when the file Is available - 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 DATE CONFIRMED TIME PHONE FAX REVIEWED YES NO REVIEW DATE INITIALS