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- EFIU lUb NUMbtH <br /> V.ti 1�M1L1.Li.�u <br /> SAN JOAQUIN COUNTY <br /> E0IRONMENTAL HEALTH DEPARTONT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 Jrv, <br /> (209) 468.3420 <br /> PUBLIC RECORDS RELEASEE-APPLICATION <br /> APPLICANT r BUSINESS/AGENCY 1 •'�/'f�/`��,,� c�L( C� r - `Vr"1 1 <br /> ADDRESS �r n • _ 2 `� <br /> PHONE — 1 I /'t��tj 7y FACSIMILE GI /------------------- <br /> TENTATIVE* <br /> -----TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS �I <br /> SIGNATURE OF APPLICANT tDATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> O OIt—f}F" INGLQIl2 UIE <br /> M I - c of w E2 <br /> s <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> P7 NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> nTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> ,UNDERGROUND TANK <br /> (MONITORIN <br /> 0 DOG KENNEL 0 DAIRY <br /> G TREATMENT PLANT <br /> IZ TIEREDDOUS WASTE PERMITTED FACILITY <br /> OR GIREMOVAL) O MOTEUHO CHICKEN RAN �❑ P�KM ER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑,PO OUSPA —71ir LAND USE APPLIC7!O SITES <br /> ❑ MEDICAL WASTE FACILITY 117 OTHER(PLEASE SPECIFY) `�'1—t C_ S'tI S r S <br /> I <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. r <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48424N <br /> 0/7&100] <br />