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UAfU RECEIVF.y ^u EMU LUU NUMBEN <br /> n 1 JFIFIFI//////VVV SAN J04NUIN COUNTYPUBLIC HEALTH VICES <br /> ENVIRONMENTAL HEALTH DIVISION �} <br /> �^V U �` 3V 304 EAST WEBER AVENUE, THIRD FLOOR <br /> l STOCKTON CA 95202 <br /> Ij (209) 468-3420 e <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT L Ct4h.( , Ieed <br /> II � - BUSINESS/AGENCY � ` <br /> ADDRESS3 �mYo_rr _ / iy-cl NEruyt ezAD 9t�8�1i <br /> PHONE- lx4 <br /> C, <br /> - -n00 FACSIMILE 01II.9 ;i- D - Z.ZZ2_ <br /> TENTATIVE`APPOINTMENT DATE — 1112- TIME q :QC) A.M <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST <br /> ,,-,$$7p8.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> IGNATURE OF APPLICANT ( /� /(UEVZ / DATE 7r1O-60 <br /> FILE ADDRESS I THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 7.1-7 KA . c4ua" LoD I a �7 S oZ ao <br /> Z3 ELM LoD1390 2 U .23 0 23a 3oS5 3c/C� <br /> 31 - ELM LO Q P es SI I 2� <br /> I ELM LaD I ) 2 2 <br /> IU l sukx�L wD� VS2 3�0 31 <br /> Ld6 W, Ca Ur lE - kAc-Y I YeS f -D <br /> Q 61 RA T W OE aA 00 <br /> 2421 c.Y <br /> .3t>31.�). ELM w� � <I�IOA-T�pVeSS <br /> 14 ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(U )CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/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 (east 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 f_E , NO REVIEW DATE _ <br /> EN 00 14 02/24/00 ' -i- <br />