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SAN JW OU)N COUNTYPUBLIC HEALTH S�-RViCES <br /> RU4104 <br /> „�JVlASTWEERA HEALTHDIVLOOR , <br /> 304 EAST WEBER AVENUE, THIRD FLOOR p( <br /> STOCKTON CA 952D2 <br /> (209) 4083420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT t'/ )%e- 4V-5 DUSINESS/AGENCY_I//),V0,nCe r/ CTO <br /> noDREss y 4 S /U W/ko q C fDe� 9.5'0805` <br /> PHONE FACSIMILE 1 // d - < `u <br /> CD <br /> �/ uuLl <br /> TENTATIVE”APPOINTMENT DATE TIME / r. ;2f <br /> (Please tlWe 7 to 10 b bines days from dale of application submittal) m Z 00 <br /> 77 -f <br /> CHECK BOX TO EXPEDITE REQU T-$78.00 FEE-REQUE T RO ESSED IN 3 UUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE O <br /> z n <br /> n + FILE ADDRESS <br /> iL Vl D lt! a� 404 <br /> �� Cls S <br /> ' 1 <br /> e 30 <br /> 5 nt , rLe �3 26r D <br /> ? 4J I - 1 5F <br /> 1 - <br /> pro . no Cites ... -xs- Us* In t Ovr' D 8 - "Rai, OM' i"S SD G.Ror),W r <br /> ENVIRONMENTAL HE,,LTH DIVISION FILES <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 In CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY b MOTEL HOTEL ❑ PUMPER TRUCIVYARPICHEM TOILETS <br /> O TATTOOMDDY PEIRCING Q POOLfSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEMOTHER PLEASE SPECIFY ADO <br /> U 3 c- �il 0 add r, <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list z1bove 6 checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (204)464-D138 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 $78.00 deposit prior to review. <br /> S. '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 W 14 01MMO <br />