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SAN JO)*{JIN COUNTYPUBLIC HEALT;t SE'i�ICES <br /> ryENVIRONMENTAL HEALTH DIVISION 7c� <br /> 1 10 3 304 EAST WEBER AVENUE,THIRD FLOOR <br /> IIF STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC. RECORDS RELEASE APPLICATION <br /> APPLICANT.Ung o-�, �R��. i�r''�'t�y i f r3�-t l� BUSINLSS/AGENCY <br /> AD011ESS,.?13 J'�o. t f 2 ,c/ /oar Sfvc Eau.,i� C `IS�Zoi <br /> PHONE FACSIMILL" y G6 -662 <br /> TEN rAl IVE"APPOINTMENT DATE" TIME <br /> (Please firvc 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO.EXPEDITE REQUEST;$87.00 FEL-REQUEST PROCESSED IN J BUSINESS DAYS <br /> >9 SIGNATURE OF APPLICANT � �c-L DATE 12LIZP ( <br /> FILL.ADDRESS - THIS SIDE EMD STAFF USE ONLY <br /> PROGRAM ELL-MLN-1-5 SEARCH <br /> l0/� !1>r`cadd,/i•y �%z_ _ S+c�c k�.�n� E� �S-�o.S— ,352 _�� <br /> 4c e ; <-- /52-1 <br /> Y — <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST) CLE=ANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> .OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR i ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPERTRUCIVYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PUIRCING O POOUSPA ❑ LAND USE APPLICATION SITE=S <br /> ❑ MEDICAL WASTE FACILITY ❑ PUDLIC WATE=R SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to t.Qn addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At (cast one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD wilk-hotify 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 /> �I. Any file not rcturrled�in the same condition as released will be rcorcdanized 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. "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 />