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SAN qPQUIN <br /> NVCOUNTYPUBLIC HEALTH— <br /> - IRONMENTAL HEALTH DIVISl v V <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 JUL 7 8 20 p <br /> (208)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATI04NARONMENT HEALTH <br /> APPLICANT . S aSINESSJAGENCY duan D If UI d jK <br /> Ur <br /> ADDRESS � JZd S <br /> PHONC aC? —�UQ FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE 7 � � TIME <br /> j (Please give 7 to 10 uslness days Mom date of application sub ttal) <br /> yam{ CHECK BOX TO EXPEDITE REQUE -3 8.00 FEE—REQUEST R ESS D 1N 3 BUSINESS DAYS <br /> /SIGNATURE OF APPLICANT DATE ° f <br /> FILE ADDRESS <br /> Izi <br /> �Cc <br /> rt {+ / r <br /> O F n s 7 r) <br /> STS r41S1 'NV <br /> S �I <br /> & <br /> hi�lIRONMENTAL HEALTH D{V151O 1 FILES ``A <br /> 5 v/2 7 <br /> (� UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT � SOLID WASTE FJt� U <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY L7 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINUIRFMOVAL) ❑ DOG KENNEL ❑ DAIRY ) <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERM]rrrLb FACILITY ❑ MOTELIHOTEL D PUMPER TRUCKIYARD/CHEMTOIL TS <br /> 0 TATTOOIBODY PEIRCING t7 POOL1SPA 13LAND USE APPLICATION <br /> SITES <br /> 12MEDICAL WASTE FACILITY 1:1PuBbr,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)464-0136 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHID files exist. An appointment for review will be confirmed <br /> approximately five business days but no laterthan 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 END 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 retumed 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 /> 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 /> EW DD 14 01l05J00 <br />