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DATE RECEIVED EHD 4CG NUMBER <br /> SAN AQ COUNTYPUBLIC HEALI..E ICES <br /> ONMENTAL HEALTH DIVISION <br /> i t 4 ST WEBER AVENUE THIRD FLOOR / <br /> AN 2 ) 20OZ � �� `'{ STOCKTON CA 95202 <br /> r I (209) 468-3420 ., <br /> ENV1R0NMEl�i t,EAJH PUBLIC RECORDS RELEASE APPLICATI ° �` UH <br /> APPLICANT ?�- BUSINESS/AGENCY � <br /> � V l <br /> ADDRESS ' C ' C � t"(le (]-t 5 [� <br /> PHONE `rr� a FACSIMILE - l <br /> TENTATIVE*APPOINTMENT DATE f� t �� O 2- TIME <br /> (Please give 7tto 10 business days from at_e of application submittal) <br /> OAJ//J 3/ <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUE T PROC SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE l <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ,O <br /> 3S <br /> Ca a-4o <br /> — c <br /> -N1_549-'" ArikNq — /' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 6/0THER <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT - 1:1SOLID WASTE FACILITY <br /> CLEANUP SITE(NON-LOP) 11FOOD FACILITY ElSOLID WASTE VEHICLE <br /> VNDERGROUND TANK(MONITORINGIREMOVAL) 11DOG KENNEL 13DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 11� TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING D POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the spac&• 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 staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 depo$it 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 />