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-' SAN JO?, IN COUNTYPUBLIC HEALTH S*ICES <br /> UN 2 6 2001 ENVIRONMENTAL HEALTH DIVISION 4f <br /> 304 EAST WEBER AVENUE, THIRD FLOOR I <br /> ., STOCKTON CA 95202 <br /> I? L;;t, iv I HEAD N (209) 468-3420 <br /> PEAPdiiT/SEFi CES PUBLIC RECORDS RELEASE APPLICATION ( L <br /> APPLICANT &,y- ^C i� C�I�V\ // BUSINESSIAGENCY �f7k\)�v I �(.��� WM1ennAa —y�l-]I\ <br /> ADDRESS <br /> � -� �� 7359 FACSIMILE <br /> PHONE 4 <br /> TENTATIVE"APPOINTMENT DATC TIME <br /> (Please give 7 to 10 bbuusiiin�'elss days from <br /> date of application submittal) <br /> b�I <br /> CHECK BOX TO EXPEDITE REQU ST.$87. g FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS + <br /> SIGNATURE OF APPLICANT q DATE tF <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH ^ <br /> V <br /> fv�*, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> O TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1 <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$87.00 deposit prior to review. <br /> 5. "TENTA'PIVE 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 /> EH 00 14 00107100 <br />