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DATE RECEIVED <br /> END 6OG NUMBER <br /> SAN JN COUNTYPUBLIC HEALTP -'RVICES <br /> n`II II ONMENTAL HEALTH DIVISr!N 9 <br /> �. <br /> l/ 4 ST WEBER AVENUE,THIRD FLOOR <br /> :,fIW � <br /> 1AN u J 20Z �� STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENVIROMAIRII HEATH PUBLIC RECORDS RELEASE APPLICA/TI <br /> APPLICANT vttlo <br /> / BUSINESSIAGENCY V <br /> Ile- <br /> ADDRESS <br /> -{D ) �1 r ^ l «e Cts r <br /> PHONE T()•'t - �- L441,0 ^` 4�QL FACSIMILE �l(.J 'C � <br /> TENTATIVE*APPOINTMENT DATE s ( 3o Q2- TIME <br /> (Please give 7 to 10 bu��ssi]i``�nn�ee�'sss days 1from to of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE/ <br /> T P OC SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> IQ <br /> — lL 1 <br /> I t`- ' R . <br /> C" a — Cc <br /> - <br /> L�42L 4� y ; <br /> J <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> t+�/ NDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT C] SOLID WASTE FACILITY <br /> Gd/OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Lr/uNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> L4AZ <br /> � ARDOUS WASTE GENERATOR CI CHICKEN RANCH 13PKG TREATMENT PLANT <br /> W TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM 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 (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 $89.00 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 />