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UA,e RECEIV�� •1I EHD LOG NUMBER �I <br /> SAN J%..,:2UIN COUNTYPUBLIC HEALTH �2VICES <br /> , 00 ENVIRONMENTAL HEALTH DIV[SIYO( <br /> n� 304 EAST WEBER AVENUE,THIRD FLOOR �' V <br /> 1 STOCKTON CA 95202 t <br /> (209) 468-3420 <br /> /^1 `^y� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT l 0I'Y (4 ` lee /'I I . BUSINESS/AGENCY V(� ,Y)A <br /> ADDRESS 0Z Oc" m:niA_l oo_ l� y c l l,� �fn me�n+��i' I 0A .91581`2 I <br /> PHONEgI(�� l4f� Y ZZOO FACSIMILE 9tt.2) •ibq - ZZz2 I�.. <br /> .-r--r�-I---�-� 7 !y <br /> TENTATIVE'"APPOINTMENT DATE 1=+4•�-a�tJ I [� TIME q •OO AM I <br /> (Please give 7 to 10 business days fr6af date of application submittal) <br /> { <br /> i <br /> CHECK BOX TO EXPEDITE REQUEST•,,,......$���7[[[8.00 FE�EQ-REQUEST P-R/OCESSED IN 3 BUSINESS DAYS <br /> IGNATURE OF APPLICANT � a/ /T LQp ' DATE 7—/ -00 :{ 1 <br /> 4 <br /> it <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY v i <br /> PROGRAM ELEMENTS SEARCH 11 ' <br /> 11 N Lbt>I, 2- a ao 1 '! <br /> iz3 ELM Lobt 3sl;'--7 2MO a 5(a1 23 0 2 S 2308 if i <br /> 31 ELr► Lvel o es I Si i Sze <br /> I ELM LOb I l2 r Yl Z?tg <br /> to I Sutool_ LO�1 3s I S2- <br /> 3�0 31 <br /> 2 CI6 L 11 a 1 --rkA c-Y s 5:z • NQ DDrels T_ <br /> Ili . W . C�RAt1Tu�JE -j GY 3:;-it C i a3 35S --7 <br /> 3520e � 3 <br /> 1 W. Rh 'T L4 1JE T2hc-Y 3.�. aL 0,iA )a-_IS a 0 li <br /> 2421 s-a� ,u <br /> i <br /> 303 tom, ELM tet' 1 GNU 1�1J�YesS� �! <br /> �/ 'f^I 1L 3 ENVIRONMENTAL HEALTH DIVISION FILES n <br /> UNDER OUND TANK(UST) NUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY ��i� <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT i <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES II <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 Ij <br /> approximately five business days but no later than ten (til) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled it <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 /> e I <br /> DATE CONFIRMED PHONE FAX INITIALS - <br /> REVIEWED �YEr, NO REVIEW DATE <br /> EH 00 14 02124100 ' <br /> II <br />