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wu L I(tbeiv cu EHD 40G NUMBER <br /> SAN JO IN COUNTYPUBLIC HEALTH *VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> /J PS7 02 P,Pii I (,. PN 12: 21+ <br /> APPLICAN(T� I �1( � p,.�I(0�/��,hp ('�BQUSIjN�ESSIAGEnNCYI/' n p, (f <br /> ADDRESS I�0�) / 2 IlJIAN�r.1�1't//1�J'�Vt , SIC . l) Oa N//�1�.�'��7 / (A / ( I 0 ' <br /> PHONE 5 i o - qYl � LVL/ F CSIMILE 51 1/ - L�1 - 62 )0 <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> ive 7 to 10 <br /> ness days from date of <br /> lication <br /> 1] CHECK BOX TO EXPEDITE REQUEST gi <br /> $ 89 00,0{F�EE-RE/QUEST-�P(yR0 E/S' Psubmittal) <br /> SIGNATURE OF APPLICANT CCCSED IN 3BUSINESS DAYS <br /> DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> BOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> CNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 13DAIRY <br /> U <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY 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 /> rt <br /> REVIEWED YES NO REVIEW DATE <br /> 'B--n lalnl. <br />