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.ill l)l <br /> DATE RECEIVED <br /> SAN JC %WIN CCUNTYPUBLIC HEALTH : "_VICES <br /> t-VVIRONMENTAL HEALTH DIVIS1098ir <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 T 1 <br /> (209) 4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> o N <br /> ATAI- <br /> APPLICANT G ��a BUSINESS/AGENCY I 1`�' <br /> ADDRESS �(/ QLQ cAfd //�� <br /> PHONE 9*•SCJ •-734e) FACSIMILE 491b• (,38 g3e�, <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST- 7 EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r- DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> l J _ 9 7 L�tY7Fi2o <br /> 32oZ M W6 S1DCZ <br /> 6 E,ASY Z o <br /> y <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> � / c r-3HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> Chi' UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> E THER CLEANUP SITE(NON-LOP) El DAIRY <br /> LY UNDERGROUND TANK(MONITORINGIREMOVAL) M DOG KENNEL p PKG TREATMENT PLANT <br /> O HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH <br /> ❑ TIERED PERMITTED FACILITY C3 'T <br /> MOTEUHOTEL ❑ PUMP ERRUCKIYARDICHEMTOILETS <br /> ❑ POOUSPA In LAND USE APPLICA11ON SITES <br /> ❑ TATTOOIBODY PEIRCING p pUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, ses in the space above. Select the type(s)of files from the list above by checking <br /> List up to ten addres <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, f any EHD files exist. An appointment for review will be confirmed <br /> EHD will notify the applicant i <br /> but no later than ten (10) days after receipt of application. The files <br /> approximately five business days <br /> ays for review. Appointments should be scheduled <br /> wilt be held for a maximum of five business d <br /> accordingly. <br /> 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. YES NO REVIEW DATE <br /> EN 00 14 OW4100 <br /> TOTAL P.02 <br />