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dl/d//20U2 lb. ul 2Ub4blllld uuE sIUuKIu,, i <br /> ATE FECIEVED EHO LOG NUMaER <br /> SAN JOA%Pp.oIN rOUNTYPUSLIC HEALTH SEF ,:ES <br /> 1 ENVIRONMENTAL HEALTH DIVISION <br /> V` ! 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON r� <br /> _I (209) 468-3-3 42020 / <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ESS/AGENCY O / <br /> ADDRESS 12 Uj 06 <br /> aa1` (� /}6/ • <br /> PHONE_ 071 / O � /04 _FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal <br /> 6r.t i 775 3, <br /> Ll— <br /> CHECK BOX TO EXPEDITE REQU ST-$76.00 FEE-REQUE 7 RQCES ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> .7 <br /> UE WEi it 0 <br /> L100 <br /> 11 V L4S ' <br /> r) <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 17 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY CI MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOIBODY PEIRCING ❑ POOUSPA ' Cl LAND USE APPLICATION SITES <br /> ❑ 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 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 $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 /> EH On 14 01105W0 <br />