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SAN J UIN COUNTYPUBLIC HEALTH S VICES <br /> 'VIRONMENTAL HEALTH DIVISICS <br /> 304 EAST WEBER AVENUE,THIRD FLOOR APR 2. 0 2.000 <br /> STOCKTON CA 95202 <br /> (209) 468-3420 ENV[R0.NIN.EIVIALI EALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PERVIT/SERVICES <br /> APPLICANT 7 �USINESSIAGENCY �//(/Q1)�L7n� (hr�0E.�1Ul!^D�7/�1PnI �.Y1C. <br /> ADDRESS {{`7 OS <br /> PHONE dQ - Q FACSIMILE P <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of applicatlo i jmlttal) <br /> a (Earlier S1+ee* hAS (Jrtort?K prfor%74 ..I <br /> CHECK BOX TO EXPEDITE REQUE $78.00 FEE-REQUES.T YROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> -71 <br /> �/ �,I' j ADDRESS <br /> tr s' <br /> N I II <br /> f. ra S C1?An fz; 5 �7 Scl Cp - <br /> I <br /> can <br /> S-6 z2b <br /> tc V hs—, 7 �/�. 02� <br /> ,��3s. a' w <br /> t USA9 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> [$ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 9Z OTHER CLEANUP SITE INON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> JP UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL O DAIRY <br /> 9 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 1:1 MOTELIHOTEL 0 PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOUSPA In LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ 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 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 appolntmentfor review will be confirmed <br /> approximately five business days but no later than ten (SD) 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 $78.00 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 /> EH ea 1� aVDWDO <br /> Sc C4 'A(2 1 q �0 <br />