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UAICKtCtrveu END I,OG NUMBER <br /> SAN' 'OAQUIN COUNTYPUBLIC HEAL- SERVICES <br /> ENVIRONMENTAL HEALTH DIVYMION <br /> 1 304 EAST WEBER AVENUE,THIRD FLOOR / <br /> STOCKTON CA 95202 0174- <br /> I� <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q Q BUSINESSIAGENCY <br /> pp <br /> ADDRESS en <br /> /_ <br /> PHONE Z� (DCR3, �7OZ FACSIMILE <br /> "TENTATIVE`APPOINTMENT DATE TIME - - <br /> (Please give 7 to 10 <br /> E uslness da m d application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.0 E —R T CES _SEGj) 38 INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS. THIS SIDE EHD STAFF USE ONLY <br /> 9j C 1L) PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP)- 13HOUSING ABATEMENT 0,, <br /> SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 'Ci'UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY . <br /> -tlt HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT , <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/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 $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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> nn�unr <br />