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SAN J(h.,.LIIN COUNTYPUBLIC HEALTH SLICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,TH1RI] FLOOR �. _ <br /> STOCKTON CA 9502 <br /> �� A[ (209) 468-3420 <br /> } M <br /> MJH PUBLIC RECORDS RELEASE APPLICATION <br /> \� 4PPLICANT /� @IlSINE55JAGENCY (if(/L��1�I �ry� &�1�� <br /> ADDRESS D S- AL1L <br /> ). n/ S d C CA <br /> l PHONE -IL/D FACSIMILE b r� <br /> 2. <br /> APPOINTMENT BATE -V TIME k 0'. <br /> (Please Hive 7 tQ 10 bwslnaer Ma Tram date of application submtdail <br /> �,yd EE' EQUEST PROCESSED.IN 3 <br /> BUSINESS DAYS_., �� / 6 1 [-� ! <br /> 8.00 F <br /> SIGNATURE F iP I!NT DATE 70O0: / e <br /> FILE ADDRESScl- <br /> s _co 2', U <br /> ENVI ONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ soUla WASTE FACILITY <br /> t-OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY InSOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) d 13OG KENNEL ❑ DAIRY <br /> KAZARDOUS WASTE.GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL)HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOSODY PEiRCING 0 PCOU$PA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O 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. Fa to 209 464-0138 or mail to t g <br /> address ip4lcated 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 field 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$78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:OD 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 /> rW 06 14 MOWN <br />