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TO esai9oa P.01 <br /> ;d SAN JOA' UIN COUNTYPUBLIC HEALTH SERVICES <br /> ElIVIRONMENTAL HEALTH DIVISION r7� <br /> 3q4 EAST WESER AVENUE,THIRD FLOOR / <br /> STOCKTON CA 9$202 <br /> (209) 468-3420 <br /> PUBLIC;RECORDS RELEASE APPLICATION <br /> WPI�LICANr rf`��"'CS`� Salo Mt�Q�BUSINES$lAGENGY ,7 SONY.PQ���'�'��^\L� L� �^��_ <br /> A)DRESS— . \yfcGZ.Vii•YAS �R\19E. eJ SE QQ . <br /> IFACSU7ILE <br /> +ENTATIVE*APPOINTMENT04TF TIME <br /> tPl¢¢aa pi�ieL7•t(w//1/lOJb/waino-5Saa7a fr dal¢of "BUSINESS <br /> submittal) <br /> CHECK BOX TO LXPEDITL REQUEST-$47.00 FEG-REWEST P OCESST1 DAYS <br /> -StaNATURE OFAPpi)CANT �nxSL� � �(�( {� DATE <br /> FIL6AODRt s THIS SIDE EHD STAFF Us .UNLT <br /> PROGRAM ELLMENTH SEARCH <br /> [iL�\ A14 `3t CON S3 X5.7 <br /> ��l F-a Y�iZS �"COCY.�CON � I <br /> Fav t�tzw�. -coc�t.� ay.�,o <br /> b <br /> tr V ,�C L U F \ 3S z dJG <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDFRGROUNp TANK Cu"CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT D SOLID WASTE FACILITY <br /> OTHER CLPANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOUI)VYA87E VEHICLE <br /> R+l UNDERGROUND TAijK(MgN{TORINGIREMbVAL) U DOG KENNEL ❑ DAIRY <br /> ❑ HAZARD'OUS WASTE GENERATOR 4 CHICKEN RANCH PKG TR£A7MGNT PLA�.IT <br /> C1TIERED'PERM[rTED RACa1TY b MOTEUHOTBL ❑ PUMPER TRUGKlYARUtCHsM TOWNS <br /> CI TATTO01BODY PHIRCING Q P60143PA ' ' D LANA USP APPUCgT10N SITES <br /> MEp1CPiL WASTE FgCIU7Y O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten,addresses In the space above. Select th'a type(s) of files from the tilt above by aheccing <br /> the appropriate bOX(es). At least one file type MUST be selected. Fax to(2091 454.0138 or <br /> aggi s inc)icated i boyo mall to t he <br /> 2. EHD will notify the appllCanti if Any EHD files exist. An appointment for review will be confirmed <br /> approximately live business days but no later than ten(10)days after receipt of application. The fires <br /> will be held for a maximum of five business days for review. Appointments Should be Scheduled <br /> accordingly. <br /> 3. A rite that IS aetivaly being wor{ted on by EHD staff may not be immediately available for review. A now <br /> APPlicatigh may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition As released will be reorganized by EHp 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 /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s• Applications received after 9:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENTDATE <br /> i TIME <br /> DATE CONFIRMED PHONE FAX )NITIALS <br /> � 14 1 :oo YES NO REVIFW DATE ' <br /> TOTAL P.01 <br />