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� �� �� LIIJ tVY I.Uiiwl� <br /> SAN JOA, /IN COUNTYPUBLIC HEALTH SERJES / <br /> Eb IRONMENTAL HEALTH ftDIVON34 EASTWEBERAVENUE,THISTOCKTON CA 95202(209)468-3420�,/� P UBLIvCiRECORDS RELEASE ION <br /> APPLICANTIAi V,E iICLI I /J BUSINESSIAGENCY �l .44,'111 <br /> ADDRESS ! L�=99��f�/'il,�L� <br /> PHON��D�') e,,_f —�U.�/)- - FACSIMILE <br /> cT-�o3TENT� ; 1 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please.give 7 to 10 business days from date of application submittal) <br /> ENATURE <br /> CHECK BOX TO EXPEOrrf REQUEST-587 .00 E-REQUEST PROCESSED IN]BUSINESS DAYS <br /> OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY O <br /> psi - /� , X380 .�3$I PROGRAM ELEMENTS SEARCH <br /> �o <br /> MAY 14 4 <br /> V <br /> 1 <br /> :Ep)VIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> QK OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY - ❑ MOTELIHOTEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> Cl TATTOOIBODY PEIRCING O POOUSPA ' ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY - O 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). Af least one file type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. END will notify the applicarit if any EHD files exist. An appointment for review will be confirmed <br /> approximately five busines�days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum lof five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being ivorked 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 dame 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES I NO REVIEW DATE <br /> ..... .. ...... <br /> TOTAL P.01 <br />