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EHD LUG NUMBER NI 0 SAN JO " IN COUNTYPUBLIC HEALTH S" -ICES i� V , r_- RONMENTAL HEALTH DIVISIO"a � r U 7�. 304 EAST WEBER AVENUE, THIRD FLOOR 1 Q STOCKTON CA 95202 p ' I I (209) 468-3420 '^ `- �j PUBLIC RECORDS RELEASE APPLICATION APPLICANT �HI ( ` 1 >°d BUSINESSIAGENCY ADDRESS 123 (1c;Mino"p (1iV 1 �p-�ed��t ()l� 9tii3i PHONE-11( C) b4 - 2200 FACSIMILE Rt(k) �7�y - 2ZZ2 TENTATIVE*APPOINTMENT DATE - i l UlJ -71 L TIME _q .OO AM (Please give 7 to 10 business days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS IGNATURE OF APPLICANT DATE :7-1a-100 FILE ADDRESS THIS SIDE EHD STAFF USE ONLY PROGRAM ELEMENTS SEARCH u N Lbet a £ a s 23 ELM Lo D 1 2380 2 5U( .23 90 2 3e 309 31 - ELM LJt,t O S57Mdtl �� 124K W , ELM Lob, I 2 0'1 SCAL'OL LO► IZ37T6 5S2U 3,sz 1 23)10 •LqE L u>J -TPa4C_Y Yes f -D O W . la RA,tJ"rL-I tJ G 1 W. (-ARA13TW OE -k RA a 2-421 Vto LL. -T02A C 169 3D3 LU' ELM p 1 <X10 A iJDyeSS ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK(U )CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. "TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME -- DATE CONFIRMED PHONE FAX INITIALS — REVIEWED �YEB NO REVIEW DATE EH 00 14 M"O - '�