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SAN J10A1N COUNTYPUBLIC HEALTH SERIES <br />ENVIRONMENTAL HEALTH DIV ON �} <br />3�4 EAST WEBER AVENUE, THIRD L I <br />STOCKTON CA 95202 <br />i (209) 468-3420 <br />PUBLIC' RECORDS RELEASE PPLICA ION <br />APPLICANT t V, t Q . I BUSINEESSIAGENCY //'/0>' <br />ADDRESS G� f�' 7 �'� f C1 CJ ;� �­7 <br />E�L L � �C� FACSIMILE <br />TENTATIVE" APPOINTMENT DATE TIME <br />(Please Qiue 7 to 10 business days from date of application submittal) <br />rNn CHECK BOX TO EXPEDITE REE QUEST - $87.00 F — REQUEST PROCESSED IN ] 'BUSINE55 DAYS <br />NATURE OF APPLICANT DATE <br />FILE ADDRESS THIS SIDE EHD STAFF USL ONL` <br />�f✓'ri) e� y. el 5• J PROGRAM ELEMENTS SEARCH <br />EOVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TAMC (UST) CLEANUP SrfE (LOP) <br />la HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONrrORING/R60VAL) <br />a DOG KENNEL <br />EO DAIRY <br />HAZARDOUS WASTE GENERATOR i <br />❑ CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />O TIERED PERMITTED FACILITY <br />❑ MOTEUHOTEL <br />D PUMPER TRUCKIYARD►CHEM TOILETS <br />O TATTOOIBODY PIERCING <br />0 POOLISPA <br />CI LAND USE APPLICATION SITES <br />Q MEOICAL WASTE FACILITY <br />Q PUBLIC WATER SYSTEM <br />CJ OTHER (PLEASE SPECIFY ABOVE) , <br />1. List up to ten addresses in :the space above. Select the type(s) of files from the list above by eheoking <br />the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0938 or mail to' he <br />address indicated above. <br />2. EHD will notify the applicarit if any EHD files exist. An appointment for review will be confirmed <br />approximately five businesb days but no later than ten (90) 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 �rorked on by EHD staff may not be immediately available for review. A new <br />application may be subm)tt�d when the file is available. . <br />4. Any file not returned In the dame 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 $87.00 deposit prior to review. <br />5: *TENTATIVE, appointment dates must be confirmed with EHD staff.. <br />6. Applications received after 1;3-.00 pm will be processed the next business day, <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />au .... - TOTAL' P.01 <br />