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SAN JOAQL�COUNTYPUBLIC HEALTH SER\�S <br /> ENVIKONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ,�� PUBLIC RECORDS RELEASE APPLICATION <br /> � <br /> APPLICANT r " 1545% BUSINESS/AGENCY 20MbO-� ee i?/H <br /> ADDRESS <br /> PHONE FACSIMILE • <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7-to 10 business days from date of application submittal) — <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$07.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY O <br /> PROGRAM ELEMENTS SEARCH <br /> D E. a� a9so �9oi �3oJ — <br /> Ice 45. INN&.CET' Zzaq, ?2.10— F F <br /> sE. rrl.,�E.c a38� <br /> E. 117.dEG a38/ 3544 <br /> -2380, X80 <br /> I/ . G2q,✓T .�3f/ �3fo, 0¢ <br /> D <br /> ENVIRONMENTAL HEALTH DIVISION FILES F1¢Y -7 <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ 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 EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> LCONFIRMED <br /> POINTMENT DATE TIME <br /> PHONE FAX INITIALS <br /> YES NO REVIEW DATE ' <br />