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..IL hL�LIVLu uw Lw im.wl.i. <br /> ��(�r I''`1•�_[�� SAN JOF A6COUNTYPUBLIC HEALTH SF 71 ES <br /> V . ' <br /> ENVWNMENTAL HEALTH DIVISION <br /> a .LU01 304 EAST WEBER AVENUE, THIRD FLOOR <br /> Ip,N STOCKTON CA 95202 r `j <br /> FILTH (209) 468-3420 <br /> LEA <br /> PUBLIC RECORDS RELEASE APPLICATION, <br /> _-PGM t�irI�FRViCES - _ - - - <br /> APPLICANTf�0.l'�' �L�D /I A&C$--EFdSINESS/AGEN/L-CIY' -C�� <br /> ADDRESS Tl�FJ� � /Z(2� r ' `( C'(' Vrt7 � � .ffVZ. <br /> PHONE ��/"(�U 2-[p�SSS FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of application submittal) <br /> r7 CHECK BOX TO EXPEDITE REQUEST-567.00 EE T OCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 0 D je-. IFIN S- ST-0C_K` —e IV <br /> _ I <br /> c <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ,. <br /> ❑ TIERED PERMITTED FACILITY Cl MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS _ <br /> ❑ TATTOOIBODY PEIRCING ❑ POOVSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC 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 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 REVIEW DATE <br /> EH 00 1A 00107/00 <br />