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Unl L t<LLLIVLU <br /> �► SAN JO?AQUIN COUNTYPUBLIC HEALTH -ERVICES EitO%OGNUMBER <br /> „`.ENVIRONMENTAL HEALTH DIVIS-r,- N <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> STOCKTON CA 95202 „!J 4io. <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION �Cr Z 0 2002 <br /> APPLICANT S f BUSINESS/AGENCY L I lufv j <br /> HEALTH <br /> ADDRESS f L/ I S <br /> PHONE (CSU r <br /> FACSIMILE 1p sU J - 3 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days fro date of appitca on submittal) <br /> C� ECK BOX TO EXPEDITE REQUEST 89.00 r G �$ R SS AUNESS DAYS <br /> SIGNATURE OF APPLICA T DATE <br /> I <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> TQC <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> )SI"-11NDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> D HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTEL/HOTEL O PUMPER TRUCK/YARDlCHEM TOILETS <br /> O TATTOO/BODY PEIRCING O POOLISPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM O 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•(s,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 $89.00 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 " P. <br /> •A nl.�n—j• ��— <br /> w � <br />