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SAN J UIN COUNTYPUBLIC HEALTH S VICES <br /> �VIRONMENTAL HEALTH DFVISIOW <br /> — l 304 EAST WEBER AVENUE,THIRD FLOOR APR 2. 01000 <br /> STOCKTON CA 95202 <br /> (209)468-3420 IR0NVf 'ENTALHEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION hEWMT/SERV CES <br /> APPLICANT / r µ <br /> / ' J J USINESS/AGENCY adua 7�ced 6-eo&urvno �PM al rnc. <br /> ADDRESS `7 D Ul/CSO Q C l/7/ <br /> PHONE aO D FACSIMILE (F <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (P <br /> lerl?�t ase give 7 to 10 business days from data of applications mlttal) <br /> a (Earlier sheer has PrlbPrlori'�k Ir <br /> CHECK BOK TO EXPEDITE REOUE 578.00 FEE-REQUESTROCESSED IN 3 BUSINESDAYS <br /> SIGNATURE OF APPLICANT DATE <br /> EADDRESS <br /> t� <br /> 10 -35 5 <br /> 7`d <br /> II <br /> u ,^a S CXTon ; 5 7,5Z e,6 . <br /> can LS7nWNf1 C i s-.17 <br /> V tc <br /> i <br /> ! USD9 s� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> t�t UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 6 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> �Z OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> JP UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 9 HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> M 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 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 applicatlon. 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 at $76.00 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 DD 1� nvDWDO <br /> Sc R4 'A12 <br />