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Liu1 LLWuL;nypv <br /> SAN JIN COUNTYPUSLIC HEALTH SEES <br /> NVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (202)488.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION, <br /> '—, w <br /> APPLICANT e�P l <br /> 01 f1 d �•'J/�((,•f-`�'�71 f'� i BUSINESSIACiEN UYI�G �' <br /> PHONE C !i �,;3 f7 Z•n _ tACSIMILk 2!r} '3 3---_G3r11E_._ �`-=�•--� z <br /> TkNTATIVE'APpOINTMtarpA7T CUA? <br /> (please give 7 to 10 bvsinO day*from dam of appbcaUon submittal) C ,\ <br /> CHECK ROX 70 EXPEDITE RE4U/E]S�T-$$7.W FEE—REQU/€S�7 PROCESSF6IN 3 LUSHNESS DAYS ( �\ <br /> SIGNATURE OF APPLICANT / fL IIiLC(P�L CUA DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SFARCH <br /> � �iik �r 1-L' -�U OI �� + ChFtrM -/kW INC• 2bbi �.>�O 8 Z <br /> ^ ZJ � L 2 <br /> C' jXo r f <br /> , J I <br /> NA 0 <br /> IGt I�, nA <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(Usn CLEANUP SnL(LOP) O HOUSING ABATEMENT a saun WASTE VEHICLE <br /> OTHER CLEANUP SrrE(NON-LAP) ID FOOD FAC11.rlY <br /> UNDERGROUND TANK(M0NI'0RINQRErjOVAL) 0 DOG KENNEL - ❑ DAIRY <br /> U 'HAZARDOUS WASTE G ENERATOR 0 CHICKEN RANCH 0 PKGTREATMENT PLANT <br /> 0 TIERFA PERMITTED FACILITY O MOTELIHOTEC ❑ PUMPER TRUCK/YARO/CftM TOILETS <br /> M TATT001GODY PEIRCFIG C POOLISPA ❑ LAND USE APPUCATION SIZES <br /> CJ. iAEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM G OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses in the space ab0va. Select the Vpa(s) of fetes from the lust above by checking <br /> the appropriate box(es). At least one file typo MUST be selected. Fax to(209L46 '138 as ryriI 10 the <br /> ddro d-fcated above- <br /> 2,' <br /> ave2: EHD will notify the applicant if any EWA files exist,.An appointment far review will be confirmed <br /> approximately five husiness days but no later than ten (10)days after receipt of application. The files <br /> will he held for a maximum of five businoss days for review. Appointments should be scheduled <br /> accOrdingly. <br /> 3_ A file that is actively being worked on by EEO 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$87.00 deposit poor to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8, Applications received after 3:00 pm will be processed the next business day. <br /> %�UNt-IRAMEa APPOINTMENT DATE TIME <br /> OffE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> � u anormu <br /> TUTRL P.¢2 <br />