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EHD LUG NUMBER <br /> DATE RECEIVED <br /> HEMMED <br /> U nSAN JOAC✓ NTYPUBLIC HEALTH SE..ICES <br /> f Di ENVIRR ONMNM ENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> NOV 0 3 2000 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATC/I,LON <br /> APPLICANT <br /> l BUSINESS/AGENCY <br /> ADDRESS <br /> PHONE 1�/ FACSIMILE — ,i <br /> "I UIV 3 ` N TIME <br /> TENTATIVE'APMENT DATE <br /> (Please give 7 to 10 business days from date of application submittal) - <br /> CHECK BOX TO EXPEDITE REQUE�S $87.00 FEE—REQUE T PROCEE, SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT TClCt /t �l/Yl��c DATE 2 -� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1,0 q92 <br /> c <br /> 0 f � <br /> O <br /> O <br /> • <br /> ENVIRONMENTAL HEALTH DIVISION FILES NOV -6 2000 <br /> C3'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY O <br /> GYOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Ga"UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 03107100 <br />