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SAN Jl JUIN COUNTYPUBLIC HEALTH S( DICES <br />ENVIRONMENTAL HEALTH DIVISION <br />J�� 0 ZOO, 304 EAST WEBER AVENUE, THIRD FLOOR J+ 5-36 <br />'--� '` <br />U <br />STOCKTON CA 95202 J <br />(209) 468420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />'APPLICANT 11 ' P /11"-f qA1 Z -Z. BUSINESSIAGENCY <br />ADDRESS I-- MYrs!-/fes S`e-e—e-+ ■ <br />PHONE � G^l FFACSIMIILLjE �WR - o6a 1 <br />TENTATIVE' APPOINTMENT DATE. /4 S 4cp, TIME <br />(Please give 7 to to buslness days from date of application submittal) <br />Llt/ EEEEvq..qqq STs 3, '/4-" <br />rD CHECK BOX TO EXPEDITE REQUEST -;87 UE$ESSED IN 3 DUS{N SS DAYS <br />SIGNATURE OF APPLICANT DATE <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SRE (NON -LOP) <br />U FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (IIIONITORINCIREMOVAL) <br />❑ DOG KENNEL <br />L] DAIRY <br />O HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />O PKG TREATMENT PLANT <br />❑ TIEREDPERMITTED FACILITY <br />U MOTEUHOTEL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOIBODY PEIRCIHG <br />U POOLISPA - - <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILDV <br />D PUBLIC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />O <br />U) <br />O <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 fill that is actively being worked on by EHD staff may not be immediately available for review. A new <br />applicatiun 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 $87.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must he 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 INITIALS <br />REVIEWED YES NO REVIEW DATE <br />