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Li .Y:[Lull-..�- :IJ iV V ilUe4uL: <br /> SAN J "QUIN COUNTYPUBL IC HEALTH VICES <br /> WIRONMENTAL HEALTH DIVISI <br /> ��R _ 9 2��� 304 EAST VVEBER AVENUE,THIRD FLOOR A ^I <br /> STOCKTON CA 95202 / <br /> E I . <br /> (209)46U-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 11QQ�1 8USINESSIAGENCY ,(' `Te�hfa.�� <br /> ADDRESS i V CJ • <br /> �� <br /> PHONE FACSIMILE 0 <br /> APP � -23 - DI <br /> TENTATIVE* PPQINTMf:NT DATE TIME 140"AO dlf <br /> (Please give 7 to 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT +.+_. e DATE ®j <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> CP. PROGRAM ELEMENTS SEARCH <br /> 25 / <br /> 236 39 i <br /> vTH 3 a3o f X367 239 2 by <br /> 94 a <br /> FNS R9 N <br /> cr 11c+o-T mea <br /> 1D2ivs,3G 77, 2- Z z2 41. 36 d <br /> rnI <br /> ENVIRONMENTAL HEALTH DIVISION FILES �p <br /> A <br /> LSC UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINGAI3ATEGENT � SOLID WASTE FAGILfF'r <br /> PA' 2' <br /> ,k OTHER CLEANUP SITE(NON-LDP) El FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> rr UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> kY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILnY ❑ MOTEL7HOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOXSODY PEIRCING El PODUSPA LAND USE APPLICATION SITES <br /> ID MEDICAL WASTE FACILITY 0 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 mall to th9 <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 submittod 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. Futuro file reviews by the same applicant may require a $37.00 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 /> RrvlcwKn Ya=c un 0PV1PW rIATC <br />