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SAN J UIN COUNTYPUBLIC HEALTH SIMICcS <br /> Ci� IRONMENTAL HEALTH DIVISIO u <br /> 304 EAST WEBER AVENUE, THIRD FLOOR _ <br /> STOCKTON CA 95202 / <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT (' HUSINESSIAGENCY U l%r'DlP�tiPt1 <br /> ADDRESS .237 „j (� ��, L nc <br /> PHONE U '�D FACSIMILE S "� <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 buainass d- s — —*•^••�� I --�+-d-{-o{.11 <br /> Y r*wn dale of appllcatian submhWl) <br /> CHECK BOX TO EXPEon-EREQUEST- 7 E- pUEST PROCESSED IN 3 BUSINESS pgy5 H <br /> �hj�` <br /> SIGNATURE OF APPLICANT _�y <br /> DATE . 2�- SOD <br /> F'I ADD 8_j_ <br /> 23 <br /> J A9 �3 19 7 mak. _ I3 Cyt <br /> Alft <br /> L G22 , w <br /> 19S” 3 Sa N <br /> do% <br /> EYEENVIRONMENTAL HEALTH DIVISION FILE S <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILr" JUN - 1 271 <br /> C1t"HER CLEANUP SIZE(NON-LOP) ClFOOD FACILITY 17 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON1Y0ftINGIREMOVALI ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrTED FAG1UTY ❑ MOTEllHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOIL M- <br /> ❑ TATTOO BODY PEIRClNG ❑ POOLISPA 4 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM 4 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. $elect the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selectod. Fax to (209) 464-0138 or mall to Uta <br /> AAArgss 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 END staff at the expense <br /> Of the applicant Future file reviews by the same applicant may require a $78.80 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 • IME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Bim 14 0143mv . <br />