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SAN J( JUIN COUNTYPUBLIC HEALTH SF-VICES <br /> •-'J �, -errJVIRONMENTAL HEALTH DIVISIOi...' <br /> >w 304 EAST WEBER AVENUE,THIRD FLOOR <br /> CA STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE AppLICATIQN; �' .�� �► <br /> APPLICANT�si l./f'J/,��/ RUSINESSIAnCNCY �y] O <br /> ADDRESS 7 w�` S� ` " CA <br /> PHONE aD — FACSIMILE f7 <br /> TENTATIVE"APPOINTMENT UATLI"V'i. TIME -00 a4u+ <br /> (Please give 7 to 7Q business days from dale cf application submittal) \ <br /> CHECK BOX TO EXPEDITE REQUEST-S - FE —R EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE r� ti <br /> FILE ADDRESS <br /> 1 <br /> ,,35 � 7 <br /> 77 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> LIQ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WA5TE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIRENtOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL U PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑ TATTOO160DY PEIRCING ❑ P40OLSPA U LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY `J 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 indiriated 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 $76.00 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 CC 44 C1J0_S(GO <br />