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..f1� '��1�V='Lr 1_ 1'J ' J:•. r 1 1 L.l.' <br /> SAN J(- 'JUIN COIUNTYPUBLIC HEALTH SFr-VICES <br /> ',w t VIRONMENTAL HEALTH DIVISIO* <br /> ` <br /> / 304 EAST WEBER AVENUE THIRD FLOOR <br /> 5. •+ t STOCKTON CA 95202 <br /> rir (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION"-,Z' <br /> APPLICANT ,SIS 2 BUSINESSIAGENCY adda7 nn fl u/�� O l <br /> ADDRESS / • G(J!( S� ' " 0A 5 05 <br /> PHONE ao - 0 FACSIMILE 7 — <br /> mm <br /> TENTATIVE"APPOINTMENT DATE 1-�t`N 141 Q j2f TIME Q oo A <br /> (Please give 7 to 90 busingss days from date of application submittal) \S J^ <br /> CHECK BOX TO EXPEDITE REQUEST-S - FE –R EST PROCESSED IN 3 BUSINESS DAYS /�� <br /> SIGNATURE OF APPLICANT DAT!" 1 <br /> FILE ADDRESS <br /> l <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 2< UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> $<OTH A CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> -K UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 5k HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOLlSPA O LAND USE APPLICATION SITES <br /> D 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 (2_09) 464-0138 or mail to the <br /> address indir- tOAbove. <br /> 2. EHD will notify the applicant if any EKD 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 EHb 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 /> S. '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 043 14 ai/aSM0 <br />