Laserfiche WebLink
SAN , XUUIN COi`lNTYPi BUG HEALTH ' i I4�S <br /> 'OtNViRONMENTr4L HEALTH DiVISIb"d <br /> 304 EAST WESER AVENUE,THIRD FLOOR M-F <br /> STOCKTON CA 95202 U.. : <br /> Nd (209)458-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> EN@s1P &''INT �?i�3 l.Y�i BUSINESSIAGE NCY uddiuC2 <br /> ADDRESS `7 &)I h0n QL� SipceM4CA E- <br /> I - <br /> f /0-5— <br /> PHONE � - U FACSIMILE 2 / // R <br /> TENTATIVE'APPOINTMENT DATE Ze t- —(,-' TIME `0 E0 <br /> �-y (Please give 7 to 10 flusiness days from date of application supmittal) <br /> u CHECK BOX TO EXPEDITE REQUEST,M EE-R EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE __�J'10(00- <br /> FILE ADDRESS <br /> 3's•�� - l <br /> 4 3sa-� <br /> ENVIR NMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M $OLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NDN-LOP) ❑ FOOD FAGILrrY M SOLID WASTE VEHICILE <br /> 13 UNDERGROUND TANK(MDNITORINGIREMOVALI ❑ DOG KENNET_ ❑ DAIRY <br /> G1 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEWHOTEL E7 PUMPER TRUCKrYARO1CHEM TOILETS <br /> M TATTOOIBODY PEIRCINC 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type($) of files from the list above by checking <br /> the appropriate box(es). At least ane file type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHID will notify the applicant if any EKD 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 END 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 TWE <br /> BATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> FN OU 1A 0110'$100 <br />