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SAN JC !UIN COUNTYPU13LIC HEALTH SF AGES <br /> _ *VIRONMENTAL HEALTH DIVISIOIr" 00/ O�O <br /> STOCKTON 5202 <br /> 31}4 EASTN CA AVENUE, THIRD FLOOR <br /> (209)468-342D <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAN IJZan ����BUSINESSIAGENCY advanced A2&0/ <br /> ADDRESS 1 '] f <br /> PHONE ao FACSIMILE (1:262) fy / <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> A (Please give 7 to 10 business days from date of application submittal) �. <br /> HECK BOX TO EXPEDITE REQ5;ZZ UVROCIESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS �J I. T,k C n� � � s <br /> JC <br /> It n t► <br /> it It i <br /> It It It <br /> aCl fin 0 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT t3 SOLED WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) t3 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONfTORINGIREMOVAL) = DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTEL/HOTEL ❑ PUMPER TRUCK/YAR131CHEM TOILETS <br /> 0 TATTOOII30DY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM OTHER X LEASE SPECIFYAyY€� <br /> Fair "5131 E-F'exvBOX.4 Orn <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 now <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 $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 /> Eri oo a aua�mo <br />