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v MAR -08-2002 _ 16:27 CAMBRIA 1707 935 6649 P.01101 "- t:110 I.VV NVMULK SAN JO*1N COUNTYPUBLIC HEALTH SEJOCES 7qENVIRONMENTAL HEALTH DIVISION 71Z �.�'I' 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (209) 468-3420 021iFR -3 P(' LP&13LIC RECORDS RELEASE APPLICATION APPLICANT �µoE"�'1 BUSINESS/AGENCY CXm1aYii)_ 11'OV�WIi'tn f ADDRESS h^7n t'�111C .S�Y�l..� SOY10`M2! CA PHONE No -7) 9303-23(68 FACSIMILE 00171 -Il, 6q -g TENTATIV&APPOINTMENTOATE S'\9 TIMEO0C) Ini.,,e n:vn v ec iA_K,m nasadays igam date of apwication submittal) © CHECK BOX TO EXPEDITE SIGNATURE OF APPLICANT DAYS DATE -3 — 8 d� ELEMENTSEHO STAFF USE ONLY PROGRAM • r .. • : �• t'Lt �� -� `- gm F�Vt• •L �I- 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 $87.00 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 DATE CONFIRMED REVIEWED YES TIME PHONE FAX NO REVIEW DATE INITIALS TOTAL P.01 o ENVIRONMENTAL HEALTH DIVISION FILES 6 0 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT CI SOLID WASTE FACILITY P �.A 18 OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE 7UNDERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY 0 HAZARDOUS WASTE GENERATOR D CHICKEN RANCH D PKU TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS ❑ TATTOOISODY PEIRCING D POOLISPA ❑ LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 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 $87.00 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 DATE CONFIRMED REVIEWED YES TIME PHONE FAX NO REVIEW DATE INITIALS TOTAL P.01