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LI IJ Luv Nui•.i�U: <br /> Jill L NLI;LIV LJ <br /> E�����1��% ��� SAN JOENVIRO MENTA HEALTH DIVISION <br /> F ',ESL 1 lSL 304 EAST WEBER AVENUE, THIRD FLOOR <br /> JAN 0 3 2001 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> _NVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Xo�� <br /> APPLICANTBUSINESSIA6E6-Y P ,A S OG <br /> ADDRESS L 0 D)RY`s S' `-� 1 1Y <br /> PHONE O ' tiZ'1.. FACSIMILE �� `� <br /> mArg <br /> TENTATIVE"APPOINTMENT ATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> E7 CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE— E1WE ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 O <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �y SOCV L <br /> I <br /> ► <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) C3 DOG KENNEL ❑ DAIRY <br /> X UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <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 $87.00 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 /> NFIRMED APPOINTMENT DATE TIME <br /> TE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 08107100 <br />