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Ul/07/2062 ib:Ub 2094671116 AaE bIUUKluii I .. 11 b" Uu <br /> urcu EHe LOG NUh10ER <br /> SAN JOADIN COUNTYPUBLIC HEALTH SEFWES <br /> / C ENVIRONMENTAL HEALTH DIVISION <br /> J 304 EAST WEBER AVENUE, THIRD FLOOR <br /> Irl STOCKTON CA 95202 <br /> (209) 468-3420 a �/ ') ,3 <br /> # � � PUBLIC RECORDS RELEASE APPLICATI[ON "y- <br /> APPLICANT BUSINESSlAGENCY e '' i a ma 24a <br /> ADDRESS- 23r9 ShquJ Rood <br /> ry <br /> PHONE ao9) ylLI 1466 FCSIMILE <br /> TENTATIVE'APPOINTMENT DATE , '1 I'I I �� TIME ��•V c� <br /> (Please give_I, <br /> to 1 husiness days from date of appllcatlon submittal) <br /> �tiiTS �. <br /> CHECK BOX TO EXPEDITE REQU $78.00 FEE-RE UST PR CE5SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS O <br /> ,tJ _ <br /> r n <br /> 3 Ir <br /> It <br /> q 301i, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 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 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY El MOTEUlHOTEL ❑ PUMPER TRUCKWARD/CHEM TOILETS <br /> ❑ TATTOO)BODY PEIRCING ❑ POOUSPA ❑ 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 (2091464-0138 or mall t9 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 /> 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 /> EN oo 14 olmuo <br />