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` GHU LUG NumuU( J/_ _0 Ay I <br /> SAN JC`_ ZUIN COUNTYPUBLIC HEALTH Sr-"IVICES <br /> llwiVIRONMENTAL HEALTH DIVISICS. .) <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 ' <br /> PUBLIC RECORDS RELEASE APPLICATION t <br /> APPLICANT 1?10Ha17-b I�A�S c2^j BUSINESS/AGENCY <br /> ADDRESS 2a1 -� -7 Vea tC-,rua-A I� �Zr�l �A 'E>I�D <br /> PHONE Z-09 5ll OL13 FACSIMILE �a 5 &9 001065 <br /> ,�1I <br /> TENTATIVE"APPOINTMENT DATE I"' '� I© OQC7 TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> i <br /> SIGNATURE OF APPLICANT «� � �°� DATE 03 ? 00 <br /> i <br /> FILE ADDRESS <br /> I n.1 arra e�l�.T"iD,.f <br /> A nl s(>OrL C` rl 1 .mow�F s a r -,,,I <br /> SW tFT-rR- `"` —' <br /> 1111 I.IAAJ Y D2�V0:7 <br /> � ��'�c��-T2UG-K STtJP 1aC� o� 50� ►� �'1--�YL �S� 't'k.c. <br /> Sty W. GWARr�a— . 35.A( <br /> No C l.L.i t j I C,cpsr, Co. 9,39, W, C.)A <br /> eZS NAV 99-)\)C-: <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> & OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ 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(5) 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 fife 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 /> FM 00 14 61!05100 - <br />