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LHU L06 NUMULH <br /> iI SAN J01 '21JIN COUNTYPUBLIC HEALTH SERVICES <br /> Lu ✓IRONMENTAL HEALTH DIVISK FQ <br /> q 304 EAST WEBER AVENUE , THIRD FLOOR 00 / 05 V <br /> STOCKTON CA 95202 <br /> (209) 468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT D/ C L- ) Von O/n/QA ^BUSINESSIA`GENCY <br /> ADDRESS III / kOh e. Aodrn /'✓' UP. o 6uiAC B <br /> PHONE 7 FACSIMILE <br /> TENTATIVE` APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> 17 CHECK BOX TO EXPEDITE REQUEST • $78.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> ST �� <br /> r <br /> 25 �- <br /> a <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> DI OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> X UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 (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 /> 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 00 41 0L05/00 <br />