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--'SAN JOA,*fTl1N COUNTYPUBLIC HEALTH SEeCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JILL - 2 Z001 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> E;'V Ii�1i`<:�i1'.1ti' _?.!_f H (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> � r� In f� t,Q' <br /> APPLICANT Lf/f If I lti U ` l �"-BUSINESSIAGENCY <br /> i <br /> ADDRESS <br /> PHONE-_70 V {� 3-3-7 FACSIMILE_.. <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please cgive'7 to 10 bbu5iinnness�days from elate of application submittal) <br /> f7 CHECK Box TO [XPED]TE REQUEST-$(17.00 FEE=REQUEST PROCESSED aVSINESS DAYS <br /> SIGNATURE OF APkICANT DATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 0 11-W <br /> VV <br /> L4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE (LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> DERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED,y ACILITY ❑ MOTELIHOTEL O PUMPER TRUCKIYARD/CHEM TOILETS <br /> Q TATTOO/BODY PEIRCING ❑ R6L1SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE'FACILITY PU13LIC 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) 464-0138 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 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 $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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 00/07100 <br />