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SAN J QUiN GOUNTYPUBLIC HEALTH SERVICES <br /> JVIRONMENTAL HEALTH DIVISI <br /> 304 EAST WEBER AVENUE,THIRD FLOO cf' p� <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTS BUSINESS/AGENCY al)"Onced (y,9-& <br /> ADDRLSS L1005— A). 0r <br /> PHONE FACSIMILE 'Uo��•p� <br /> i <br /> l i DD --U C <br /> TENTATIVE'APPOINTMENT DATE + TIME � �;z G7 <br /> (Please Dive 7 W 10 b siness days from dale of appli"con submittal) �� Cc <br /> M :E: <br /> CHECK BOX TO EXPEDITE REQU T-578.00 FEE-REQUE T RO ESSED IN 3 BUSINESS DAYS y Z o C <br /> SIGNATURE OF APPLICANT DATE <br /> FILE A RESS <br /> ` 1 <br /> Al 0. <br /> e 30AA 3 <br /> t <br /> iw- 3 ZCr �� <br /> H I 1 SP <br /> . Grp no si.ks ... 7F U5-Fed In qOVr DB "Ro-IhR"' V'S.SD .6zo7�.j�r3 r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SfTE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ 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 t] MOTEUHOTEL ❑ PUMPER TRUCKJYARPICHEM TOILETS <br /> 0 TATTOWBODY PEIRCING Q PDOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SY$TFM 'PKO-MERPLEASE SPECIFY AHQVL <br /> W-Qlks !� `ftc IJS J <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the I[st dbove 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 $78.00 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 /> EN 09 i4 0114 V( <br />