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DATE RECEIYEO _ EHU LOG NUMBER <br /> JOUIN COUNTYPUBLIC HEALTH RVICES <br /> �AE HEALTH DIV <br /> 304 EAST WEBER AVENUE, THIRD FLOORMAR 3 1 2003 <br /> I I <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENviHUIdMEivi F+EIa�IN PUBLIC RECORDS RELEASE APPLICATION <br /> PERMITI <br /> \ o� / <br /> Cp <br /> APPLICANT BUSINESSIAGENCY <br /> ADDRESS a <br /> PHONE ao 9) yILI 7 1046 FACSIMILE (209 <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 usiness day from date of application submittal) _ i7 <br /> CHECK BOX TO EXPEDITE REQ{l�ST1A\ <br /> �$7(8..00 FEE-y REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT IU' � A� ln`In\) DATE <br /> FILE ADDRESS <br /> G <br /> 6 <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 /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ��,�. ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED, PERMITTED CIL Y ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <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 <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 $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 /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01/00/00 <br />