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LI{UL OU NUMULH \ li <br /> AI�SAN JOAQUIN COUNTY <br /> 9ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 304 EAST WEBER AVENUE,THIRD FLOOR <br /> f. STOCKTON CA 95202 �= <br /> t Y11 ti �003 (209) 468-3420 <br /> 'PUBLIC RECORDS RELEASE APPLICATION <br /> LICANT C' 1—1 ` BUSINESSIAGENCYy �+�fir`}f 1:-P1 I n e*C, <br /> DRESS1 CG� �y <br /> 1 <br /> SHONE �,� - $. FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$69.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS ( Y <br /> SIGNATURE OF APPLICANT \ DATE S <br /> -- d <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> i, <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 1 SOLID WASTE FACILITY II <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> A_TIERED PER FACILITY ❑ MOTELIHOTEL '❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> 3 TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE-APPLICATION SITES <br /> :3 MEDICAL WASTE FACILITY ¢.,OTHER(PLEASE SPECIFY)_ W6- � 1.f,tii►C ff("r dl?1 <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 /> Z. 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. 1 <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. I <br /> 6. Applications received t after 3:00 pm will be processed the next business day. <br /> - + <br /> i' <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE, FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48.02-006 <br /> 3l26r2003 <br />