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e410VtzVUr UU:42 FAX 209 9480821 Q1003 OOJ <br /> DATE _ rd(r-� 1�/��I-� -� ^' ) EMO Loo HUMBER I <br /> =l ;[[ AN JO UIN COUNTYPUBLIC HEALTH SEI"*, kES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR S O ZOOS 304 EAST WEBER AVENUE,THIRD FLOOR /1 / <br /> ` ^ STOCKTON CA 95202 <br /> t Iv1�ItiJT HLFl�i (209)468-3420 <br /> 0' 1T/SSERVICB $�N✓IBLIC RECORDS RELEASE APPLICAII(IN <br /> APPLICANT ��+%� P �' /�L �"j�vCt BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE 9�g ^ .3_`�.T FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE ' A-, TIME _�.L/ e <br /> aa ' <br /> (Please give 7 to 10 businx days Nom date of appliration submlttal) <br /> CHECK BOX TO EXPEDITE REQUEST.487.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS V <br /> SIGNATURE OF APPLICANT �4 _ DATE <br /> PILE ADDRESS THIS SIDE:FIiD STAFF U`7E ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> e�eZ 00 �pVn�r flus 131ud 7' - �`� '• '�'j <br /> O v ,4^ rlv � <br /> IU <br /> _ I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENTOTHLID WASTE FAl:ILnY <br /> ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITYCLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING)REMOVAL) ❑ OOG KENNEL �DALRY <br /> HAZARDOUS WASTE GENERATOR 13CHICKEN RANCH O PM.G'(REATMCK?PLANTr f7"TIERED PERMITTED FACILITY O MOTWHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOfSODY PEIRCING ❑' OOUSPA LAND USE APPLICATION STIES I <br /> ❑ MEDICAL WASTE FACILITY PUBLIC WATER SYSTEM ❑ OTHE R(PLEASE SPECIFY ABOVE) <br /> 1J <br /> 1. List up to ten addresses In the space above. Select the types) of flas'f Jm t,Te list shove elt� t ckin9 <br /> the appropriate box(es). At least one file type MUST be selected. Fvx to 209 464-0138 or fall 0 the <br /> address indicated above.. <br /> Z 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 recsipt of application. The files 1 <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 Immediate ly 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 reorgantzed'by EHD staff at the expense <br /> of the applicant Future file reviews by the same applicant may requiro 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 PAX INITIALS <br /> REVEWED YES NO REVIEW DATE <br /> q Nov", <br /> PI czd n Lt-41 f <br />