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UtifEkiE.CE1Vh nyJ EHOLOG NUM131-:R <br /> SAN J UIN COUNTYPUBLIC HEALTH VICES <br /> ENVIRONMENTAL HEALTH DIVISION Cs� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY_ t�r2la1_ <br /> I r <br /> ADDRESS 123 <br /> PHONE v` 220 D FACSIMILE <br /> . C) -7/ <br /> TENTATIVE*APPOINTMENT DATE - 1 L� TIME q 00 A-" — <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 DATE — QU <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> u N LbD t a <br /> 'T Tap <br /> Z3 EI M <br /> ..� 38o a (..Q 1 23 © 2 W 3 � <br /> E�r-t mod 0 <br /> ELM LOr`nta 1 l I <br /> t .Z <br /> la-7 sum+- wt�� 3s 1 Z3 SZ 51:5 E <br /> -L a 6 WCa i-,3 e --rRA <br /> Iu W . C�2t,tA-TL-A -T G`t' 3a z� C <br /> 3 35� SZ LQ <br /> 't q &IR!� `T rJE ilrZA C Ne 3�.. a c: 6 S 0 <br /> 421 <br /> L" <br /> -TPA G Y :3 5-a�, rv-�, <br /> X03 tom, E Lt�-1 Lob � �[�10 t��YesS� <br /> ENVIRONMENTAL HEALTH DIVISION FILES I <br /> D TANK UST CLEE4NUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHLJNDER CLEAN (UST) M SOLID WASTE VEHICLE j <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO113ODY 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 I <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 (110) 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 Y :; NO REVIEW DATE _ <br /> EH 00 14 02124f00 <br /> Y Y <br />