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UFU t RLULwLU EHD LUG NUMBER <br /> SAN JO;'')UIN COUNTYPUBLIC HEALTH S -'-"VICES <br /> L"WVIRONMENTAL HEALTH DIVISIOW <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUB IC RECORDS RELEASE APPLICATION <br /> �'` <br /> APPLICANT •C_ BUSINESS/AGENCY <br /> ADDRESS / �7 n API-e' <br /> PHONE 07tg— �/lp / I�� FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE J ` 2-- TIME JO.`O d Q <br /> (Please give 7 to 10 buslinesd days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQU $89.00 FEE—REQU ST PROCESSE3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT D IN DATE S9 dZ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> C lC TD <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(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 ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ 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 $89.00 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 7/� TIME A <br /> DATE CONFIRMED C/ S HONE FAX INITIALS--' <br /> REVIEWED YES NO REVIEW DATE y <br /> n n -nnr <br />