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u ��u 16 SAN JZsAQUIN COUNTYPUBLIC HEALTH- 'RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AUG 2 8 2001 304 EAST WEBER AVENUE, THIRD FLOOR <br /> ENVIRONMENT HEALTH STOCKTON CA 95202 <br /> PERMIT/SERVICES (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 2&46(1 d-�ggfZ BUSINESS/AGENCY <br /> ADDRESS 6 <br /> PHONE FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO,EXPEDITE REQUEST-$87.00 FEE—RE-QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE F —0 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1144 1 <br /> '�. <br /> all <br /> lvvr.m tZ !T--0--LJJ� 'u ALal <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 D SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM THER(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 wi�li notify the applicant if any END 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 PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> eH 00 14 08/07100 <br />