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DATE PMENM ;. <br /> SAN JUIN COUNTYPUBLIC HEALTH �4wAVICES '`s�.� ' '� <br /> ENVIRONMENTAL HEALTH DIVISION '`` <br /> 304 EAST WEBER AVENUE,THIRO FLOOR UEC 1D ?�Oa <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE'APPLICATION 'Ers�;r.-^�' �f+�1 <br /> APPLICANT Riul Alms BUSINESWAGENCY �i k1 ' ,i � �nG <br /> AaoREss wt.,/allw� Ry. 0& uita 'Bi t i rz, CA <br /> PHONE CI 1 J"524 T k Q FACSIMILE '714"_&Gd-1 <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to'10 business days from date of application submittal) <br /> CHECK SOX TO EXPEDITE REQUEST-SM00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS UA, <br /> SIGNATURE.OF APPLICANT �� rte---� DATE <br /> FILE ADDRESS <br /> ENVIRONMENTAL.HEALTH OMSION FILES <br /> 3M UNDERGROUND TANK(UST)CLEANUP SITE(LOP)- ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 10 OTHER CLEANUP SITE(NON LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> JIII UNDERGROUND TANK(MONITORINGtREMOVAL) © DOG KENNET. 0 DAIRY <br /> 181 HAZARi><C1US WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERWT'ED FACILITY o MOTELIHOTEL CI PUMPER E APPLICATION SILT T(xLETS <br /> ❑ TATTOOA300Y PEIRCING 0 POOLISPA CI LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE'FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABCN 1.) <br /> 1.,. . List up to ten addresses In the space above. Select the type(S)of files from the list above by ch(+cking <br /> the appropriate box(es). At least one file type MUST be selected. FaX to(209) 464-0138 or mail ? j <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. Th T files <br /> will be held,for a maximum of five business days for review. appointments should be sch6dule:l <br /> accordingly. <br /> 3. A file that is actively being.worked on by EHD-staff may not be immediately available for review. A novo <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$18.00 deposit prior to review. <br /> S, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after. 3:00 pm will be processed the next busine.as day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW GATE <br /> u <br />