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t I <br /> ..I L hL�,uvw LI:U LUV NUMULH ! '; i <br /> w v �.. N S�' N JOi JIN COUNTYPUBLIC HEALTH S VICES `' <br /> t0011RONMENTAL HEALTH DIVISI00d 00-0a _"L <br /> C)IC oew �OLk 304 EAST WEBER AVENUE, THIRD FLOOR <br /> JAN 24 20010 !� STOCKTON CA 95202 ��f <br /> ENVIPONINJIENTAL HEALTH <br /> (209) 468-3420 <br /> r,e\AIT I SERVICFS PUBLIC RECORDS RELEASE APPLICATION <br /> PL"APPLICANT Y Y - BUSINESS/AGENCY <br /> ADDRESS <br /> PHONE FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please dive 7 to 10 business days from date of application submittal) <br /> E7 CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS ` <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> AN AL <br /> fly c Z)a0'fY-1C'I r, V -e <br /> Do I--OtiI. <br /> 1 <br /> LSD <br /> ENVIRONMENTAL HEALTH DIVISION FILES❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑_ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY JAN 3 1 2000 <br /> ❑ OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ 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 siaff 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 01/05/00 <br />