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SAN JOAiM<IN COUNTYPUBLIC HEALTH SEh-.-OICES <br /> �C ENVIRONMENTAL HEALTH DIVISION _-- <br /> J \\ 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCI�TON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION_ <br /> APPLICANTBUSINESS/AGENCY <br /> + _ p <br /> ADDRESS �Lp��� ��.1.. �`^^ (��cxs-SCA <br /> PHONE ` \ 1.ZZ( FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please 0*0/--) <br /> e 7� to 10 businessdays from date of application submittal) <br /> Cif INT�1 , �L <br /> CHECK BOX TO,L•XPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> . DATE <br /> FILL"ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> 1 PROGRAM ELEMENTS SEARCH <br /> A— <br /> a — <br /> ',d <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 /> )Kf UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHE-MTOILETS <br /> ❑ TATTOO113ODY P131RCING ❑ POOUSPA _ O 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 /> ttic 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 samc condition as released will be reorganized by EHD staff at the expense <br /> Of the apRlicant. Futurc file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. "TENTAT.f'VE 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 00/07100 <br />