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SAN JOAQUIN COUNTYPUBLIC HEAL i H SERVict <br />'NVIRONMENTAL HEALTH DIVISIr <br />'--"3G4 EAST WEBER AVENUE, THIRD FLOD✓ <br />FEB - 5 2001 <br />STOCKTON CA 95202 <br />(209)468-3420 <br />Iiill . PUBLIC RECORDS RELEASE APPLICATION <br />BUS W ESSIAGENCY <br />4_� �(S J <br />TENTATIVE" APPOINTMENT DATE 9 F.Pb MOL t !►tlf )TIME I ID*• V O <br />(Please give 7 to 70 business days from dais Cf applie ttion submittal) <br />CHECK BOX TO EXPEDITE REQBUSINESS DAYS DATE C <br />�iSIGNATURE OF APPLICANT l D/ <br />� <br />:I <br />AL HEALTH DIVISION FILES <br />`�. UNDERGROUND TANK (UST) CLEANUP SITE (LOP)'6 <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON40P) <br />FOOD FACILOY <br />❑ SOLD WASTE VEHICLE <br />UNDERGROUND TANK (MONI70RINGIREMOVAL) <br />❑ DOG KENNEL <br />❑DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIEREDPERMITTED FACILITY <br />❑ MOTELRIOTEL <br />❑ P LIMPER TRUCKlYARDIC HEM TOILETS <br />❑ YATTOOMODYPEIRCING <br />❑ POOUSPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />D PUBLIC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />O <br />1 <br />W <br />W <br />UI <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 />wilt 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 ENP staff may not be Immediately available for review. A new <br />application may be submitted when the Elie 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 />S. 'TENTATIVE appointment dales must be confirmed with EHD staff. <br />G. 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 />EN 00 14 ... <br />