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LII 0 1 W---, <br /> SAN JO ' ?UIN COUNTYPUBLIC HEALTH SF 'VICES <br /> t,,4VIRONMENTAL HEALTH DIVISION/ <br /> APR 1 9 2001 304 EAST WEBER AVENUE,THIRD FLOOR �� <br /> STOCKTON CA 95202 <br /> ENIVI HEALTH (209) 468-3420 <br /> PERPu1IT/SER'MES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 4N/41I,) !q jZuC1..4AN BUSINESSIAGENCY APR 20 <br /> ADDRESS./2 `� �X SS 'LZI U 9 <br /> PHONE Z� �L' "- U15 L4 FACSIMILE �10 <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � Nc� c�V� DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> f 3 Ctl�'i9�tT /'� Lr✓ /G/�, �3S1, 239`I X301 loco. --3c3 _ �F �.Z5 0_3 4, O <br /> U Lau <br /> o 'A <br /> LAI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDERGIR No TANK(UST)CLEANUP SITE(LOP) P OUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> HER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NDERGROUN0 TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA " ' ❑ LAND 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 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 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 EHIJ 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 00 14 oammn <br />