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:EIYED EFu L06 uJn4:i.,1 <br /> V✓ SAN JOIN COUNTYPUBLIC HEALTH SER S <br /> V 5WRONMENTAL HEALTH DIVISION <br /> ULT 2 2 2001 / . 304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> �_.. (209)468-342D <br /> fHv " LPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT i/ Af /'(.�fY��[/Ll�Z-. BU5INES&AGENCY <br /> ADDRESS '}} <br /> PHONE(-"00 �`7��`�3`7"� FACSIMILE 20q y'e'6i'51 <br /> TENTATIVE`APPOINTMENT DATE %/01 TIME //"ai-�> <br /> (Please give 7 to 10 business days from date of application submittal) <br /> UNi Ts 31 4 <br /> Q CHECK BOX TO EXPEDITE REQUEST-567.00 FEE-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DATE <br /> FILE ADDRESS THIS SIDE EMD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 'Sol W.. k4t-6f Tv, L ZF CA <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY In SOLID WASTE VEHICLE <br /> /CS UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> X HAWDOUS.VASTE GENERATOR ❑ CHICKEN RANCH rt PKG TREATMENT PLANT <br /> 17 TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL 0 PUMPER TRUCKIYARDtCHEM TOILETS <br /> E2TATTOojDODY PEIRCING E3POOLISPA 13LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of fifes 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 Ute <br /> address lndir,.gted above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review M ill 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 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 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 /> FM W 14 03W OO <br />