Laserfiche WebLink
SAN JO#1N COUNTYPUBLIC HEALTH Si ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 W T <br /> (208) 46$-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT � aUSINE55/A <br /> GERCY C>e0 (Icf/,Gf)flj/'dAr�iP /r( r� <br /> ADDRESS S3 d deM/L <br /> PHONE 09 '� 7140,& -.__FACSIMILE��� <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please glra 7 to 10 bugsmessydaays from date of <br /> application su6mHto <br /> CHECK BOX TO EXPEDITE REQUE5T-37 .0 FEE-REQUEST PROCESSE IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ] <br /> \ - FILE ADDRESS <br /> V � <br /> 5 v) <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X UNDERGKOUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SQUO WASTE FACILITY <br /> Q� OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAC)LITY ❑ SOLID WASTE VEHICLE <br /> 0� UNDERGROUND TANK(MONITORINOlREtdOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMF17ED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYAR=HEM'TOILETS <br /> ❑ TATTOOi5ooY PEIRCING Q POOLISPA ❑ 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 chocking <br /> the appropriate box(es). At (east one file type MUST be selected. Fax to(2091 464-0130 or mail to the <br /> �ddfess indicated above <br /> 2. EHD Wfll notrfy the applicant if any EHD flies 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$70.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications receiv9d 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 /> Fll Do 14eviG _ <br />