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L <br /> ti <br /> LI IU LQU NUMU LIt <br /> SAN JOA IN COUNTYPUBLIC HEALTH SE ICES'-"":-"k;' ` <br /> pcl• I N <br /> ENVIRONMENTAL:HEALTH DIVISION � ;;;• .:.,�s�,�;;:,,, <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ,p PUBLIC RECORDS RELEASE APPLICATION <br /> APPLECANT �`J�� � 7_ �r BUSItdE551AGENCY O�1S (3 <br /> ADOHESs q� J CJ C <br /> PHONE I C[ 1 Z f V FACSIMILE L <br /> TENTATIVE"APPOINTMENT DATE 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 /> SIGNATURE OF APPLICANT J DATE . 4 — h —Uv <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Lf 5 a381 ;2 320 <br /> r <br /> s <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Yom- UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT _(Z/SOL[D WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITOR INGIREMOVAL) ❑ 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 /> C7 MEDICAL WASTE FACILITY ,PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I <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 /> C 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 /> CONFfRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EN 00 14 02/24100 r <br />