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LU IL..{t; I�7 LI0 Lul.riu 1_1 <br /> R IE[D)SAN JOE 'JIN COUNTYPUBLIC HEALTH S' JICES <br /> E.-TtIIRONMENTAL HEALTH DIVISION" <br /> JAN 2 9 2001 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 r <br /> ENVIR(iidMENF HrALTH (209) 468-3420 f <br /> PERMIT;'SERVIUS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT��O/7f/ - P! ✓; 1311INESSIAGENCY ✓/ !// ��f��/���f�C�l <br /> ADDRESS Z. Z <br /> PHONE a 4- FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please jive 7 to 10 business days frorn date of application subrnittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$B7.00 FEE_ —AREQUEST PROCESSED IN 3 BUSINES5�AXS <br /> SIGNATURE OF APPLICANT DATE <br /> r <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> r <br /> IL! ( E <br /> S I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK (UST)CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> • OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> C3 UNDERGROUND TANK(MONITORINGIREMOVAL) In DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLfSPA kf .ND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 7 ❑ 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 $87.00 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 HONE FAX INITIA <br /> REVIEWED YE.§2 NO REVIEW DATE <br /> EH 90 14 MUM <br />