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DALE RECEIVED EHD NU <br /> SAN J0v,4UIN COUNTYPUBLIC HEALTH`eRVICES ` <br /> ENVIRONMENTAL HEALTH DIVISION , <br /> 304 EAST WEBER AVENUE THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIOR- PR -g pt, 129 <br /> APPLICANT 1Q � (:, BUSINESS/AGENCY t' leE�nQ OQ I�S <br /> ADDRESS <br /> PHONE ��, >� FACS,I/MILE n2 <br /> TENTATIVE*APPOINTMENT DdTE �Y X TIME <br /> (Pea �foto 1rs in�ys fr m date of a plication submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST P SED AU3�RESS DAYS <br /> SIGNATURE OF APPLICANT ` DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> golo -t. G <br /> 41 <br /> 4 to 1-7 <br /> '17 <br /> 0 <br /> 0z :!�; <br /> %03Q 13523 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 9� <br /> L. JNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O'}�ZpRDOUS WASTE GENERATOR 19-CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ PER TRUCK/YARD/CHEM TOILETS <br /> TIERED PERMITTED FACILITY 173MOTELIHOTEL <br /> ❑ TATTOO/BODY PEIRCING ElPOOUSPA LA1vD USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 13OTHER(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 END staff may not be immediately available for review. Anew <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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO RFVIFW nATF <br />