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' Il 'V LSk4, SAN JOA UIN COUNTYPUBLIC HEALTH SERICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUL - 2 2001 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON -3 95202�� <br /> NVIRUivP,i :i '. , .=A.IJH (209) 468-3420 <br /> E <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT U�/7l VI Q/I��1 I l 4 1�Le,BQU,SINE55/AGENCY L ,' e ,,^y <br /> ADDRESS_ <br /> '�J O� ()2 l f /A/iAP I VW (J(yC�Ij�'I �CJ�(yQ(n� �jC 1 (1 <br /> PHONE. (� � &L O -3-7 ' <br /> FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE- TIME <br /> (Please 0ive'7 to 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$07.00 FEE-REQUEST PROCESSED BUSINESS DAYS <br /> SIGNATURE OF APkICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ( <br /> UVULA Js, <br /> r _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND <br /> TA <br /> NK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> DERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TI ERE-D PERMIT TED ACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PE-IRING OLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTEFACILITY 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) 464-0130 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 fila 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 $07.00 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 /> F <br /> MED APPOINTMENT DATE TIME <br /> FIRMED PHONE FAX INITIALS <br /> i YES NO REVIEW DATE <br />