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L)1-1�-_UUU 1�'-s►�Fll.l 1"1'(l.11'I I(J 1 �sY��" L, 15� (� �1 <br /> SAN JG�41JIN COUNTYPUBLIC HEALTH SER ..,ES s EKN !yj <br /> rr O ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR �A N 14 2000 <br /> STOCKTON CA 95202 EN Vi RG fv!M EIV'-F,4 t � <br /> (20)468-WO PEH 1�11 T i c— _ HEALTH <br /> ALTH <br /> PUBLIC RECORDS RELEASE APPLICATION E)ER IC,._5 <br /> APPLICANT G ( �t BUSINESSIAGENCY U Q�` '11'S�t7Ll' }L\ "� �l nt jIC• <br /> ADDRESS <br /> PAOXE "f aO FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please glvc 7 to AD busine"days trate daft of application submltat) <br /> CHECK BOX TO EXPEOITE REQUEST-$78.0D FEE-REQUE PkOCrSSFDIH39SUSINF53DAY5 <br /> SIGNATURE OF APPLICANT _ ^. DATE O <br /> FILE ADDRESS <br /> r C <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> el*u,�RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(MON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> tibyAIDERGROUND TANK(mom►TORINGAREMOVAL) 0 DOG KENNEL O DAIRY <br /> 43 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> • TIERED QER.MrTTED FACILITY 0 KOTEUHOTEL D PUMPER TRUCK/YARDICfiEM TOILETS <br /> O TATTOanmy PEIRCtNG O POOIISPA O LAND USE APPLICATION SITES <br /> 173 LAEOICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the typo(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Flly,to f2091 4§4-0138 or mail to the <br /> address intdicated above. <br /> 2. EHD will notify the applicant if any EHO 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 fora 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 ST8.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5. 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 RMEW DATE <br /> w t+ woos <br /> TOTAL P.02 <br />