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SAN J <br /> OA(1- 81N COUNTYPUBLIC HEALTH SEW <br /> CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUL BER AVENUE,THIRD FLOOR <br /> 304 EAST WE <br /> STOCKTON CA 95202 . <br /> (209) 468-3420 <br /> . ES PUBLIC RECORDS RELEASE APIPLIUA ATION <br /> APPLICANT a ('. eBUSINESWAGENCY <br /> ADDRESS <br /> , <br /> PHONE 7 FACSIMILE 3 <br /> . -7o4 -3 <br /> TENTATIVE*APPOINTMENT DATE :TIME <br /> (Please give*7 to 10 business days from date of application submittal) <br /> 3j <br /> CHECK BOX TO EXPEDITE'E REQUEST-$B7.00 FEE-REQUEST PROCESSED IN BUSINESS DAYS <br /> L <br /> SIGNATURE OF AROLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PR:bGRAM ELEMENTS SEARCH <br /> W `77 <br /> [ ,_Ir <br /> ENVIRONMENTAL HEALTH [DIVISION FILES <br /> rl <br /> UNDERGROUND TANK(UST) CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 0 THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY b SOLID WASTE VEHICLE <br /> DERGROUND TANK(MONITORlNGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH b PKG TREATMENT PLANT <br /> TIE-RED PERMITTED,JACILITY EI t4OTELJKOTEL .,C3 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO/BODY PEIRCINGLis- <br /> PA 0 LAND USE APPLICATION SITES <br /> U 110)L I r <br /> I-) MEDICAL WASTE-FACILITY WATER SYSTEM E3 OTHER(PLEASE SPECIFY ABOVE) <br /> I pil' <br /> f. <br /> List up to ton addresses in the space above. Select the typos) of tiles 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 ton (10) days after receipt of application. The files <br /> will behold for a maximum of five business days for review. Appo. ntments 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 fild not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Fut6ro file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHE) staffl! <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 REVIEWIDATE�l <br /> eH oa 14 00I67100 <br />