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10/2612001 114:07 2i1946RP' 3 FIFTia FLUIDR <br /> N�7a neWreo PAcf �jz�- <br /> SAN JAIN COIJNTypVBLJC HEALTH SERVOS enoiwwaae. /{' <br /> II <br /> ENVIRONMENTAL AL HEALTH DIVISION <br /> 304 EASE WEBERAVENUE,TNIF2O FLOOR w / <br /> > STOCKTON CA 95202 <br /> OCT 2 9 Z Q 1 (200)4"_U2o <br /> PPUBUC RECORDS RELEASE APPLICATION <br /> APPLICANT� wya <br /> ADDRESS_7L.LZ_IP�Or %1- ,--�i{a U2 K ➢f>c e C Z g , ,.�,� /'R 9 S n 3 <br /> PNOHE``J J( )A73o— IDU FACSIMILE L5-3o) <br /> . TENTATIVE'APPOINTHENT PATE_ fI L7 lo lr TIME 2' 30 p <br /> �iaase glut 710 70 6�nass drys coin oats or application w4lnAlal) �rn <br /> r—I UiC//7'Si �i <br /> L-a CHECK BOY TOEMT-01%REOIILST.g76. 0//FEE—REQU11ntgROC SED IN 7 BUSINESS DAYS <br /> SIGNATURE Or APPLICANT DATE _LU jr0l <br /> FAX AUDrr6bS THIS SIDE END STAFF USE DNLY <br /> PROGRAM CLCMCNTS SEARCH <br /> O ,YC C(G <br /> E t <br /> C,4e <br /> ° - s Cw 3 �D <br /> ,,,r ENVIRONMENTAL HEALTH OIVISION FILES <br /> I°* U"DEROR00N0 TAM<(UST)CLEANUP SITE(LOP) 0 HOUSING AUATEAYENT 0 SOLK)WASTEFACILaY <br /> 0 OTHCR CLFANuF Erre(NoN{OP) 9) FOOD FA"nY 0 WASTE VEHICLE <br /> 9 UNDERORDUMD TANK(M0HIrORI[CrREMDVAL) O DOG KENNEL O DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKENRANCN D FWGIR;ATMENTPLAW <br /> 0 TIERED PERMITTED FACH.IrV 0 MOTELAHOTEL 0 PUMPER TRUCKIYARDICNEM TOILETS <br /> TAWOOMCbY PEIRCINC 0 PDOUSPA 0 tAND USE APPUCATWN SRbs <br /> 0 mFoK:ALWA=e!FAcLry n PUBLIC WATER SY$TDM 0 OTHER(PL.EAS@SPECIFY AOOVE) <br /> 7. List up to tan addresses in the space above. Select the type(s)of Ides from the list above by checking <br /> the appropriate ba*es). At IeWA one file type MUST be selected. Fax to }4s4-07,,78 or mail to Ihp <br /> address indicated abov6 <br /> 2. EHD will notify the applicant if any EH[I files exist An appointment for review wig be Confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a ma7omurn of five business days for review. Appointments should be schadwed <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review_ A ntW <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same Condition a$released will be reorgan¢ed by EHD s1aH at the expense <br /> of the applicant, FUriW01116 reviews by the same applicant may regUlre a 578,00 depos)t pflOrta review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be prOcessvd We next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ev �� ranroo <br />