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UA L-RECEIV - EHD LUG NUMBER <br /> `J SAN JCk, , UIN COUNTYPUBLIC HEALTH �,�VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> AL a- <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 11 <br /> APPLICANT P_ed BUSINESS/AGENCY VV'nm <br /> ADDRESS 123 ("onornA4o-L 0; r lj-, �`YLP ✓Q Vv�Pn�-7�" 0�- 9tiBl�/ <br /> PHONEq 1 C56 `i 2200 FACSIMILE CI_�l 'T&q — Z222 <br /> TENTATIVE"APPOINTMENT DATE - - �/ Z TIME q .ODA-" <br /> • (Please give 7 to 10 business days frod date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> IGNATURE OF APPLICANT A, X DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> u Lbo a T a0 <br /> z 3 I:L LO D► 3 S� -7 _\�,j 360 a U_12-W-0 2 SO 309 <br /> 31 ELt'-1 LU�1 0AIJ <br /> i ELM LOD l 1 r'Y1 I •ZSA9 <br /> j0-1 Sino►- L-0 D 1 3 5-:-Z 6 1 SZ 3�0 31 <br /> L q 6 w, -TRA C-Y s !Y-3- (�!,,: Yes T -r-) <br /> ►u w . �9-A►JTu+Jc -c cY 3�• 2:7 C'C a3 3s� 3S2Ce <br /> 1 L). Rh �T L4 0G k(ZAC>v -3 U ILL", <br /> 2L12 i Na 1_t--.`� "Tf2� G Y 3 S �(� ►�:�, � <br /> E L-M Loi' I Z_�u I,TDDYesS 7 <br /> "L` l l T -3 4 L ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLE NUP 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 /> [� HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLJSPA ❑ 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 the464-0138 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 L ` -'- <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 02/24/00 <br />