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Elle 6OG NUMBER <br /> \ SAN Jr4QUIN COUNTYPUBLIC HEALTH RVICES � <br /> v i1VIRONMENTAL HEALTH DIVIS�1 <br /> (j I3 EAST WEBER AVENUE,THIRD FLOOR <br /> U( 1 STOCKTON CA 95202 <br /> (209) 468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_�R('�n/�}I V/ /�r1 B(0 BUSINESS/AGENCY <br /> ADDRESSI �• L• rl I aL 1��. L�1'�It/(-b <br /> PHONE-& Z �y.1��.� b 3 r/(. FACSIMILE <br /> Lm_ <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> [ <br /> CHECK 80X TO EXPEDITE REQUEST•$89.00 FEE-REQUEST ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT '7 � DATE <br /> FILE ADDRESS _ THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> W.. l7 pt v1 rtG t21�. <br /> H 17 29Q_ <br /> ENVIRONMENTAL HEALTH DIVISION FILES J ��/ <br /> O'SINDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT 13 SOLID WASTE FACILITY OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 42'HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ 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 /> 1111111(11' <br />