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>♦ LIiU LUG NUMULk <br /> 0 LJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT_ <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> IVII`lY `l U 2003 (209) 468-3420 <br /> ;PUBLIC RECORDS RELEASE APPLICATION <br /> I _ <br /> aPPLICAN'r.-: ° '� BUSINESSIAGENCY <br /> ' '� 44 <br /> kDDRESS EJI V('./J', ( �` r' I l,1 h CS G `� L }-� J <br /> 'HONE �,� �` - �. FACSIMILE �' J -�] C )� Mom <br /> s <br /> TENTATIVE'APPOINTMENT DATE TIME ■ <br /> (Please give 7 to 10 business days from date of application submittal) - 3 <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S G <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> %l� L•„} - i t,��c 1.� 1 � <br /> LZ.` UaLC2 e. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Y UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT jtf\SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 7Z_TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 7 TATTOOIBODY PEIRCING ❑ POOL/SPA O LAND USE.APPLICATION SITES <br /> 7 MEDICAL WASTE FACILITY .Q',,OTHER(PLEASE SPECIFY) 'C k� 4 <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 /> Z. 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 filethat 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 /> 1. Any file not returned in the same condition as released will be reorganized by EMD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may'require a $89.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5. 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 /> EHO 4802.006 - <br /> 7126l2007 <br /> r <br />