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DATE RUC7-NED <br /> 2wc /� SAN JO AN COUNTYPUBLIC HEALTH Sl 'ICES E.10 LOG NixoEFR <br /> f .ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIPD FLOOR ���� <br /> j Q STOCKTON CA 95202 C <br /> (209)46a-3470 tJ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT S E3USIxESS/AGENCYQv4Or L - <br /> t cr �c Itiv�O a t a scn c. <br /> ADDRESSlJ Ull s [irc��Te�t C-A ` 57.0 <br /> PHONE 2 G"J - 3 p ( S FACSiMILC Z Q q - 2.3 <br /> 17ENTATiVE*APPOINTMENT DATE TIME <br /> (PI <br /> oa*e give 7 to 10 business days from date of application Submittai) �~^ <br /> uk'17-5 415 <br /> CHI=CK BOX TO EXPEDITE REQUEST-3t17.DO FEE—REQUEST PR =r IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �.-/ r � DATE � � V_r_1 <br /> FILE ADDRESZi TMIS SWE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> f„J <br /> �r•l � S�. w�'t ti�a Y <br /> Z1 d 7 <br /> chtia! _,2 Iv <br /> Ottw� <br /> 4Af4 WIM " <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ZUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING A6ATEMFNT C] SOLID WASTE FACILM <br /> GKOTHER CLEANUP SITE(NON-4.OP} ❑ FOOD FACILITY ❑ SOUD wASTE VEHICLL <br /> M-*0 RGROUNDTANK(MoN170R1NciRr=mOvAL) In DOG KENNEL CRY <br /> Gy HAZARDOUS WASTE GENERATOR 12-C-HICKEN RANCH ❑ PKG TREATMENT PLANT <br /> CI TIERED PE"V TED FACILITY 0 MOTELIHOTI;L ❑ PUMPER TRUCKIYARD1CHrIW TOILETS <br /> Cf TATTO01600Y PLIRCING ❑ Po tAi-X CI LAND USE APPUGATION SITES <br /> li'l-'ME.DICAL WASTE FAGIIlTY ❑ PUBLIC WATER SY5TEU Cl 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(209146"138 or mail to they <br /> _4ddress Fndlcated shove. <br /> 2. EHD will notify the applicant if any EHD files exlst, An appointment for review will be confirmed <br /> approximately five business days but no later than ten (11 D) 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 wonted on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is availabic. <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$87.00 deposit prior to review. <br /> 5. =TENTATIVE appointment dates must be confirmed with F_HD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOJNTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />