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� )i SAN ,' %QUIN COUNTYPURLIC HEALTH 'RVICES <br /> �L:l `ENVIRONMENTAL HEALTH DIVISIbi <br /> MAY Z 21001 304 EAST WEBER AVENUE,THIRD FLOOR- 2g 01 <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> _ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT `� �' ! J��.T BUSINESSIAGENCY cc"1 0(0}r L GCr1�i�7 >�C�i'so r crj.F.TG <br /> ADDRESS <br /> PHONE OD�-� � G�.�/ B FACSIMILES <br /> TENTATIVE"APPOINTMENT DATE: 7/f 7ro I TitAE _ fO : �+•� ` <br /> (Please give 7 to 10 business days from date of application submittal) <br /> Q CHECK BOX TO EXPEDrrE REQUEST-$ 7.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ee /d_ �•!�f�.�+ c DATE /2/�0 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> -�" �,b u r '�.� 1 �� a9G o 9•s3 �35.a <br /> e- <br /> sc- lar- <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> OCUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> eN,OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL. ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 11 TATTOOIBODY PEIRCING 0 POOLJSPA ' . J9C LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Q 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 END staff at the expense <br /> of the applicant. Future f31e reviews by the same applicant may require a$87.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. 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 />