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/ SAN JC`WiN COUNTYPUBLIC HEALTH SE 'ICES <br /> . <br /> �VIRQNMENTAL HEALTH DIVISION- <br /> 304 EAST WEBER AVENUE,THIRD FLOOR _ 11 <br /> �I A STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT BUSMESSIAGENCY ddlviioed KCEJ .�) I�l��/(��� , <br /> ADDRESS .937 <br /> y /7 t. k)oad' Sttj&t&,4L. , � �/75' <br /> PHONE &9 rry 'IiOQ FACSIMILE w9- �r� / - / �y -- <br /> TENTATIVE'APPOINTMENT DATE TIME MAY 2 S N I <br /> (Please glV9 7 to 10 business days from date of application submlBal) <br /> i r1EALTH <br /> S4 CHECK BOX TO EXPEDCC'E REQUEST- 7 . 0 E— pUEST PROCESSED IN 3 BUSINESS DAYS 11.. ��ES <br /> SIGNATURE OFAPPLICANT ---_` DArE Z <br /> 23 Q <br /> f10.�31917 <br /> &Lci z_ s/ <br /> /lna2 /G 23VI Vwo/, 9c-u F '2 �► <br /> S lcc� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY JUN — 1 2001 <br /> OTHER CLEANUP SITE(NON-LOP) ❑ rOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTOWBODY PEIRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> C3 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 (21391464-0138 or malt to the <br /> address indicated a¢ove <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 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 Futurelile reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. •TENTATIVE appointment dates must he confirmed with END staff. <br /> 6. Applications received after 3-00 pm will be processed the next business day_ <br /> C CONNRMI=D APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> I <br /> LREVIEWED YES NO REVIEW DATE <br /> Bf 00 1� U'Iq]Aio .'V --- <br />