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I L)AI E RECkl4EHD LU(i NUMHkR <br /> hf SAN JG. . UIN COUNTYPUBLIC HEALTHURVICES <br /> ENVIRONMENTAL HEALTH DIVISION " "x <br /> 304 EAST WEBER AVENUE, THIRD FLOOR '' <br /> t i STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> L I�`t t li eye + <br /> APPLICANT r7 _ BUSINESSlAGENCY <br /> ADDRESS I C-3 ` , l I <br /> PHONE grr�� � - 210 FACSIMILE C1t,U1 1 1D`t Z2�2 <br /> 77 <br /> TENTATIVE*APPOINTMENT DATE f Z_ TIME g .QQ AM <br /> (Please give 7 to 10 business days fro date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> IGNATURE OF APPLICANT DATE DQ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Q. UZaA Lbe a 7a0 <br /> x a E L_M LOW 1 3 S�-"7 _�w 2360 a Le t '-23 Q .2 Fol 303 <br /> 3i E LS``l L_O� O e S S T + 5 <br /> i ELM Low M l rn <br /> IST <br /> 1 u w . (a 2 rJ T -T cY GL <br /> 3b ' <br /> 35� 3 Le <br /> �2) S a 0 <br /> -�••. .-- .- - �-- -- _ � v t�1�'---=--- ..:�.---=r�-_��,�-Ar�Ye-..557 �. _ _._ <br /> qENUP <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK{UST)CSITE(LOP) 13 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> Cl TATTOOIBODY 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 <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 END files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten ('Yid) 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 prn will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YE: NO REVIEW DATE _ <br /> EH 00 14 02124100 - <br /> } <br />