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U10 LUIS NUMBLN <br /> UH I C hCI.G .�V <br /> SAN JOAQUIN COUNTY <br /> Etw litIRON <br /> EASE EBBE HEALTH DIRD FLOOR <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASEE APPLICATION <br /> BUS <br /> APPLICANT INESS/AGENCY <br /> C q <br /> ADDRESS 41 <br /> �y r7 • 2 `� ,( ,� (`Sg) Z <br /> PHONE — II� /T � 50 FACSIMILE <br /> �� ♦°../ e..yi. kJ <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) /, <br /> MCHECK BOX TO EXPEDITE REQUEST.$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS ' ���, <br /> SIGNATURE OF APPLICANT ze, DATE <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> C> Pj69-7-H I NGLQI✓L 61'V J IE <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> P�7J tJNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> .OTHER CLEANUP SITE(NON-LOP) 13FOOD FACILITY O SOLID WASTE VEHICLE <br /> Rf NDERG ROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> C3 }JAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL E3__PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRGING ❑ OUSPA LAND USE APPLICATIO SITES <br /> ❑ MEDICAL WASTE FACILITY In OTHER(PLEASE SPECIFY) <br /> 1 <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 /> a , <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4342.0 6 <br /> M612003 <br />