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.22 <br /> FROM : NOR Environmental PHONE NO. : 209 369 4228 Sep. 25 2 2 0 24EM <br /> VNII MtI:tN[U _ F <br /> ` _ r SAN JOSIALIN COUNTYPUBLIC HEALTH SE OVICES <br /> ENVIRONMENTAL HEALTH DIVISION / r_ <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 2 5 202 STOCKTON CA 95202 <br /> SEP IDD (209)468-3420 SEP 2 5 2002 <br /> u�ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> EN <br /> PF pUICANT 1 BUSINESSIAGENCY �V'"r'0K---LL <br /> ADDRESS KL. 0 r - 0 <br /> PHONE 3201 FACSIMILE y09 ZZg i <br /> ✓J <br /> 9N IVEAPPOINTMENT DATE TIME <br /> r- W ease gi e 7 to 10 busines ays m date i application submllt I <br /> ,�] I <br /> CIIECIfBO EXPEDITF;REQUEST-$89.00 FEE— Q TPR ES ED IN 18USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ZS D 'L <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> o , <br /> Lo D <br /> C ' Lod-' <br /> m� <br /> S+. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> VoNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) 11FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ; UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ 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 flies 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 $89.00 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 /> F <br /> ED APPOINTMENT DATE. TIMEFIRMED PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br />