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` �♦ _ `.� <br /> SAN JO ,UIN COUNTYPUBLIC HEALTH S'�'WICES lM1U lUG NUM6lli <br /> el <br /> @KVIRONMENTAL HEALTH DIVISIG..,v <br /> 304 EAST WEBER AVENUE,THIRD FLOOR vtj�:7A SC eylp�o t rc;— <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT V-MAR D A-"S O <br /> •-f BUSINESS/AGENCY GC°" -)11rsE <br /> ADDRESS-Z"c• -7, -7 \j0A1.v\.t0.vt kl,,C `rlpa tom*, �>"5U L A X153 5 l.. <br /> PHONE Zo`t 561cl ()z-` 3 FACSIMILED 00/065 <br /> TENTATIVE*APPOINTMENT DATE Mlk(u-H to i --Dorn TIME <br /> (Please Hive 7 to 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT )3 0'j DATE 02 7 100 <br /> FILE ADDRESS <br /> SW tFT-r"(2-A nl SFU(_C- rle�\ 5W NFT u. `� ,I$1 Pe.\+a %_qtr <br /> Cv�-oMHv�T'c.�`:C�n.rA lyul S.l.�acat,l.� wA� �s�l� _ <br /> 'SKF=G�,y:f tt IALa� ? � =A�NlS (III tJAVY ve,vi� roo; <br /> D E 2O L.--rQ-6 L.1C S To P Ido% or IT-A5 IA 4-1�>9-- 3 S I � <br /> -'Sly W. G\AAa.T-v- 3S� l� <br /> oMc�,Lt ► c, sr C�. �� t,J, c�iA�-'�� ,c 7 <br /> Oz�s NAVY VO\JC y►' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Nil UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> IR OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ® UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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. Anew <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 /> EH 00 14 01/05/00 <br />