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-" SAN Jf 'JUIN COUNTYPUBLIC HEALTH SF-VICES <br /> ._�rWiRONMENTAL HEALTH DIVISIO,ftw 7 t <br /> = i. ` <br /> tr' � 304 EAST WEBER AVENUE,THIRD FLOOR <br /> zyr v STOCKTON CA 95202 <br /> ? �� r (209)468-3420 <br /> sa PUBLIC RECORDS RELEASE APPLICATIOI ;< " <br /> (' <br /> APPLICANT tthT � BUSINESSIAGENCY Qduun d OE/1U�bD <br /> —.�- <br /> ADDRESS <br /> ^--II D FACSIMILE Vk r/7 Ie <br /> PHONE G6 <br /> 1 �s TIME O 00 <br /> TENTATIVE'APPOINTMENT DATE ubmittal) <br /> Vi <br /> (Please give 77 t e buslnass days tram date o!appl+cation s <br /> ((�� /TSF2, poo . <br /> II CHECK BOX TO EXPEDITE REQUEST-S FE -REST PROCESSEO IN 3 BUSINESS DAYS t!�G <br /> SIGNATURE OF APPLICANT tl <br /> 2w DATE <br /> FILE ADDRESS <br /> f <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 2( UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT MSOLID WASTE VEHICLE <br /> D WASTE FACILITY <br /> OTHER CLEANUP SITE(NON4-OP) ❑ FOOD FACILITY <br /> KVtUNDERGROUND TANK(MONITORINGIRE00VAL) 13DOG KENNEL ❑ DAIRY <br /> 1 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ HA7-ARTIERED OUSWASTEPERMITTED OFIUTY ❑ MOTELIHOTEL ❑ PUMPERTRUCKIYAROICHEM TOILETS <br /> ❑ TATTOOIDODY PEIRCING M POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List Lip 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 12 9) 464-0138 or mail to the <br /> address indirated above. <br /> 2. EHD will notify the applicant If any EHD tiles 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 . EHD staff prior to review. <br /> at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $768.00 deposit p <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 LAPPOINTME.NTATE TIME <br /> DATE CONFIRMPHONE FAX INITIALS <br /> REVIEWEDNO REVIEW DATE <br /> EH DO U C11GL40 <br />