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DATE RECEIVED <br /> loll r,=t ;�_. SAN 'AQ COUNTYPUBCIC HEAL7f �HDhOG NUMSER <br /> r ;: ;{ lJ� SERVICES ' <br /> ONMENTAL HEALTH DIVISION <br /> ST WEBER AVENUE, THIRD FLOOR 2 rZOOZ STOCKTON . <br /> CA 95202 . <br /> EPNVI(;OMMENi HEAUfH (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATI _" ' <br /> APPLICANT BUSINESSIAGEN[CY V t <br /> ADDRESS Q <br /> PHONEp Y 4. ,_. —FACSIMILE — �l <br /> TENTATIVE*APPOINTMENT DATE 30 02— TIME <br /> (Please give <br /> 7,,tt/o 10 business days from ate of application submittal) <br /> 1 <br /> MCHECK BOX TO EXPEDITE REQUEST-$89.00 FEE REQUE T PROC SED IN 3 BUSINESS DAYS ¢ <br /> SIGNATURE OF APPLICANT JU DATE l a- <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 40 44 <br /> t <br /> - 5, eAA e <br /> Cat <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> i <br /> rl7NDERGROUND TANK(UST)CLEANUP SITE(LOP) © HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> YTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> )HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> yy TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ <br /> TATTOO/BODY PEIRCING ❑ 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 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 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 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 /> REVIEWEDYES NO <br /> REVIEW BATE- <br />