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kilL <br /> �1 � SAN, �qQUIN CQUNTYPUBLIC HEALTH " 'RV(CIrS d" � <br /> cNVIRONMENTAL HEALTH DIVIS:`_4 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR _ <br /> STOCKT'ON CA 95202 <br /> ` (209)468-3420 +� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPL1 N —��rrElU��SINESS/AGENCYnp_" man <br /> A RESS 93 7 load, <br /> Hor1E FACSIMILt MAY 1 <br /> TENTATIVE*APPOINTMENT DATE � r– s �� � T1ME f,cAl1 H <br /> (?tease give 7 to 10 buslness days from date of application submittal 1 i <br /> 1 raj F <br /> J. <br /> � �h�� 1� arch • r, <br /> CHECK BOX TO EXPEDITC REQU -578.00 FEE–REQ STP OCE SEA IN 3 8USINES3 DAYS i • �S <br /> SIGNATURE OF APPLICANT DATE Q <br /> FILE ADDRESS <br /> a numbt a - <br /> Al C tri 11 tic <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOIS) d HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY ❑ SOLJD WASTE VEHJCl B <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR Ci CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 71ERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCKJYARDJCHEM TOILETS <br /> ❑ TATTOOIBODY PEiRCING 0 POOLJSPA Q LAND USE APPUCA71ON SITES <br /> C7 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> !• t-Ist 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 selectad. Fax to (2-(-*)464-0138 or!DAII to the <br /> addrgss•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(90)days after receipt of application. The files <br /> will be held for a MaxiMUM Of five buSlness days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. Afile that is actively being wonted on by EHD staff may not bo 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 app€icant, Future-file reviews by the same applicant may require a $78.00 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 /> =-H w fi airoa�co <br />