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UAIG NLCLIVEU AMU LUG NUM11UEK <br /> 'SAN JOP UIN COUNTYPUBLIC HEALTH S VICES <br /> � $ EWIRONMENTAL HEALTH DIVISIO , ( , <br /> ` 304 EAST WEBER AVENUE,THIRD FLOOR <br /> UR 2 8 2000 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> cN VIi70N viEPv r\L. I-1L PAFUBLIC RECORDS RELEASE APPLICATION <br /> � iv11 -`I <br /> APPLICANT a_\ BUSINESS/AGENCY I,}'el 0 fJV U. SU Y� <br /> ADDRESS r17)�_ LV\ <br /> PHONE a.OR 36 7-3701 FACSIMILE 209( �� <br /> TENTATIVE*APPOINTMENT DATE ��Tl 1 3 — 7 ) Q,�yW U TIME el"Z <br /> n W <br /> (Please give 7 to 10 business days frolfi date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$78.001 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT a ' DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �23S-1 csT <br /> 9 <br /> ENVIRONMENTAL HEALTH DIVISION FILES d <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT In SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 13DAIRY <br /> HAZARDOUS WASTE GENERATOR, ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> -TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM 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 $78.00 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 /> EH 00 14 =241oo <br />