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` LHU WG NUML3W <br /> SAN JC -WIN COUNTYPUBLIC HEALTH S'-RVICES <br /> 'SKVIRONMENTAL HEALTH DIVISI6...v <br /> 304 EAST WEBER AVENUE, THIRD FLOOR sc C=1N) l rt— <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT T111AAP-0 l�A".�5 o�J BUSINESSIAGENCY (Oto"__F't10.SE �L <br /> ADDRESS �'°� 7 VCAe-VkAO�,vt N.JZ ' ix�Z �-) c� �A0'11;A: S-VO R53 5 <br /> PHONE 2� rJ �Z�3 FACSIMILE <br /> 65 <br /> TENTATIVE'APPOINTMENT DATE_!",k(2-t_H TIME 00/0 <br /> (Please give 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-- L �4�» DATE 03 7 00 <br /> FILE ADDRESS <br /> 1 5rvtrlLl"Z�r� <br /> SW%FT 1-R.N rJ'4?01-T- 5\,v,� �t v�tr a �• sn vo F:lc <br /> �s s��s-c� z+a cru Curia-��- �•.� " S.� <br /> Cv�-on�PSo l;v�.G1Ar►IA lyu �.l.+acvl,lJ wor 3s,�{� <br /> till I.Jp.V Y D21 v,�'l- ra c;A' to <br /> til v��Ut.�-T2VE-K 51bP 100% o' 4ov t t � 1(Z 3 S �t <br /> _ -'Sly W. C_ AAOrT'V-L9— 3S <br /> ame k_L'1 c.3 t Ia sT Ca, 9' t�J• C�Alti->�i� ,c T <br /> L►,1rt�(�- t-n► -tT !.K- sw= 0?-S NAVY V O V C-: oe <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> & 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 ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TA'T'TOOIBODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY CI 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 01105100 <br />