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Fes" Yl <br /> J 0-GJ4- F3�Je 09 4]Ar1 > RCr1 TO SvFJ <br /> ' CMIi LW.;NUMIlLR <br /> SAN JO OUIN COUNTYPUBLIC HEALTk SERVICES �} <br /> ONVIRONMENTAL HEALTH DIVISION L <br /> d4 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420' <br /> P B I RECORDS RELEASE APPLICATION <br /> U L , <br /> I E <br /> APPL CANT � lQ� �C.r BUSIl�lE551AGEHCY <br /> N LDG <br /> I - <br /> I <br />� ADDRESS Cac- E. <br /> I� <br /> f PHONE I FACSIMILE z3� <br /> LE <br /> ' TA * Il _ ' V L��I • <br /> itl�tr�T�v IVE� APrViNTftIENT ATE r 12--00 TIME {/�� <br /> (Pleasa Give 7 to 19 buslness days from data of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST•$8�FE£-REQUEST PROCESSED IN 3 BUSINESS DAYS f ) <br /> SIGNATURE OF APPLICANT 6ht DATE IO 14100 <br /> I � <br /> I <br /> FILE ADDRESS ,THIS SIDE END STAFF USE ONLY <br />� <br /> 4 I PROGRAM ELEMENTS SEARCH <br /> llJ jr- aG 11 Ire ti - <br /> IIS' q6 {- — <br /> ril I rr l I33 ' t-� l <br /> Ill w, <br /> 1141- kY c Gp <br /> +-k <br /> A)j o <br /> -r�► <br /> t N <br /> I; ro <br /> t - `k '']] <br /> ENVIRONMENTAL HEALTH DIVISION FILES �/� t L,11krr <br /> ��NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ktOLID WASTE FACILITY <br /> d FOOD FACILITY SOLID WASTE VEHICLE <br /> ,PSt OTHER CLEANUP SITE(NON-LOP) ` <br /> a NLErRGROUND TANK(MONITORINGlRE�OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> I ❑ ❑ PKG TREATMENT PLANT <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH a ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL <br /> 4l TATTOOISODY PJ=IRCING M P60USPA 4 ❑ LAND USE APPLICATION SITES <br /> ,( MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> [. List up to ten addresses inl the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). A least one file type MUST be selected. Fax to 209 464-09 8 or mail to the <br /> address indicated above.i, <br /> 4 <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five busine ' s after receipt of application, The files <br /> s days but no later than ten(90) day <br /> will be held for a maximurliof five business days for review. Appointments should be scheduled <br /> I <br /> accordingly. .l <br /> 3, A file that is activelybeinglworked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted Whon the file is available. I j <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 filg reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment bates must be confirmed with EHD staff. <br /> S. Applications received afte3:00 pin will be processed the next business day. <br /> 1 5 <br /> I <br /> i CONFIRMED APPOINTMENT DATA TIME <br /> QATE CONFIRMED i PHONE FAX INITIALS <br /> t <br /> REVIEWED YES NO REVIEW DATE <br /> bi 00 14 00107/06 ` <br /> I <br /> TOTAL P.02 . <br /> i <br /> ;l <br />