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UHiL-RLGLwLU r EHD 4OGNUMBER <br /> SAN JOPwOUIN COUNTYPUBLIC HEALTH L,4VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Opq 304 EAST WEBER AVENUE,THIRD FLOOR �� <br /> 2=? <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESS/AGENCY I ISI 02 11r,f� ( `� PI !9' 213 <br /> ADDRESS <br /> I q34 - <br /> 2J L!(Il.60CA ' /t- J . 5 � a&(,l'/L/U bot <br /> /, "�/ `�/1n <br /> PHONE J 1 O - "I J - � �OD F CSIMILE 5� - `7 ! / 1 y� ILS <br /> TENTATIVE*APPOINTMENT DATE /� TIME - <br /> (Please gi`vveems77 to/10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.0/FEE R REQUEST IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> LDv .S PLa�lirol3a06 L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 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(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM 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 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 /> •R nt.nnr. <br />