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/ 1=mu Loc.rALWOLA <br /> 'a3 ED , <br /> SAN JO UIN COUNTYPUBLIC HEALTH SERV <br /> :C <br /> Q <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 0 L T Z 2 N 10, 04 FAST STOCKtON CA 95202 D FLOOR LTJ 2, <br /> �[J (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT z �...r BUSIHESSIACENCY <br /> ADDRESS Asdls <br /> PHONE �O FAC [MILE 5 /��� �/ <br /> MI / <br /> TIME �/• �� �/�' <br /> TENTATIVE'APPOINTMENT DATE amsort submittal) <br /> {Pleaso pllva 7 t%;9 bums• '5'from <br /> 'qto of aLmllpp <br /> CHECX BoX TO EXPEDITE REQUEST-$&?.Do FSE_REQUEST PROCESSED IN 3 BUSINESS DAYS / { <br /> SIGNATURE OF APPLICANT — DATE _ / �l�l <br /> FILE ADDRESS THIS SIDE EHE)STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARtCN <br /> CA <br /> ENVIRONMENTAL 14EALT14 DIVISION FILES <br /> CLEANUP SITE(LOP) I7 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> oTHF-R CLEANUP <br /> TANK(UST} ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> OTHER Cl.1=AAlUP SITE(NDN-LDP} <br /> UNDERGROUND TANK(MDNITiDRINGIREAtOvAt) Q DOC KENNEL O DAIRY <br /> ❑ CHIC RANCH a PKG TREATMEHT PUNT <br /> tOZARDOUS WASTE GENERATOR ❑ CHIC JIIDTEL ❑ pUtAPER TRUGWYARDICHEDA TOILETS <br /> ❑ TIERED PERMnT'ED FACILITY ❑ POTEUNO0QSPA ❑•LAND USE APPLICATION SITES <br /> ❑ TATTOO(DODY PEIRCING C3 PUBLIC WATER SYSTJ=M ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL.WAS F FACILITY <br /> 1. List up to tea 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 MAST be selected. .Faxx t (209)464-0138 or retail to ft <br /> aOdress Indi ed a P e. Y appointment fir review vrdl be confirmed <br /> 2. EHD will notifythea licant if an ENID files exist. An aPP <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 /> acordingly. EHD staff not be immediately available for review. Anew <br /> 3. A file that Is activelybeing worked on by Y <br /> appilcation may be submitted when the fila Is available.Will be anized by EHD staff at the expense <br /> 4. Any ilea not returned In tate same Cs by <br /> yttithee game applicant ant may require a$8 '•00 deposit prior to review.. <br /> of the applicant. Future file reviews by <br /> S. 'TENTATIVE <br /> TATIVE appointment dates roust be confirmed #hs RD next bu laws day_ <br /> 5, received after 3:00 pm will be processed <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATECONFIRMEa PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> FA OO %4 ONVIOD <br />