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SAN J6: 'JUIN COUNTYPU13LIC HEALTH SF�VICES <br /> %teiVIRONMENTAL HEALTH DIVISIO. <br /> 304 EAST WEBER AVENUE,THIRD FLOOR APR r 0"L000 <br /> STOCKTON CA 95202 EI�VNf;OiVRrE ITAL HEALTH <br /> (209)468-3426 PERIMT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT // � �J/� � ) 7 S7USINESS�AOENGY adyancey��l fT�'a&UM?>1/Yle/J rY1C. <br /> ADDRESS `7 Q WI L S� Q L' �!7 .Ja Os^ . <br /> PHONE crD FACSIMILE f7 — JSP <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> as days from dale <br /> (Please give 7 to 10 businOTS tlo'; mlttal) <br /> Earlier g)+ee* has oIrtart�K .P� k ••� <br /> HECK BOX TO EXPEDITE REQUE S78.00 FEE—REQUES ROCESSED IN 3 BUSINESDAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ADDRESS <br /> 7`d _ <br /> dz <br /> l n � <br /> can STOnS,a7 lJ. 02/� <br /> t <br /> I nUSQ 9 <br /> 3Sa c� -H r;. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> IF. UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> C3 SOLID WASTE VEHICLE <br /> IX OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> );) UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> $ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEVHOTEL ❑ PUMPER TRUCKIYARD(CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOLISPA ❑ 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) 464-0136 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 579.00 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 /> EN as ice. avown <br /> -S r \+ 412 1 q '00a <br />