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SAN JCMUIN COUNTYPUBLIC HEALTH VICES <br /> LERVIRONMENTAL HEALTH DIVISS <br /> 304 EAST WEBER AVENUE,THIRD FLOOR5� E�Ptfl t ' <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT VIOA P-D t- ON" S 0'1 BUSINESS/AGENCY (:Ito <br /> ADDRESS-'a"1 I 7 VQ.VIG"MWK N.1c -*1's Z-—I 0 1�Aot�sTU C \ <br /> PHONE Log 5q CZ-13 FACSIMILE aQ9 61-09 00/065 <br /> TENTATIVE`APPOINTMENT DATE Mk(2vN fal -Look TIME <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 \--3��301J DATE 0312-7/00 <br /> FILE ADDRESS <br /> 10 Srvr-K7-01�j <br /> sW tFT Anls(x�f>� 1£it Svj 1FT W-1 Pct+e <br /> 1�,Fi5 sFt�-lam ^Z.t� W CtL�Q--t'E� W - S�2 <br /> CDLOMAO(1vSCJ+.NA 144 5•t•1�.IC°L.til1^)�r 3S�ra — <br /> �iMGtW:r.� MfaT 2A� (:A�M9 till IJAVY D121V� �o�; 33 LJ <br /> VAm VE'PUL.TQ.UL1CSTi7f 1601 or ATA5 N �" � 3S Yk.(. <br /> rei.,Js w. < Io�J 5rart sts w, c H 4ftr�ls� 3 5.a <br /> DMEI.I.IN I `D ST C'.U, q' W, C%ARTEVfZ T <br /> Lrtr�Q1Srra1 T2M.K s 0?,S NAV ORaVG 1M' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 9 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 TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ 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. 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 3:00 pm will be processed the next business day. <br /> r <br /> FIRMED APPOINTMENT DATE TIME <br /> E CONFIRMED PHONE FAX INITIALS <br /> EWED YES NO REVIEW DATE <br /> EH 00 14 01105100 <br />