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L -1,: .:V VU 1 , .:10 1'.1A VV1 <br /> DATE RECEIvEfl <br /> SAN JO ` IN COUNT`fPUBLIC HEALTH S!'^VICES <br /> ERONMENTAL HEALTH DIVISIO <br /> 304 EAST WEBER AVENUE,THIRD FLOOR (-�-�f <br /> STOCKTON CA 95202 I 1 <br /> (209) 4683420 _ <br /> PUBLIC RECORDS RELEASE APPLICATeIdO, tN,,,, <br /> APPLICANT ti BUSINESS/AGENCY <br /> ADDRESS 12 <br /> PHONE <br /> FACSIMILE <br /> TIME <br /> TENTATIVE'APPOINTMENT DATE r <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK SOX TO EXPEDITE REQUEST- 7 EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> --� DATE J9 /I aD <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> IF <br /> t <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ SOLID WASTE FACILITY <br /> 111 UNDERGROUND TANK(UST)CLEANUP SETS(LOP) 0 HOUSINGOD ABATFMENT p SOLID WASTE VEHICLE <br /> ❑ THER CLEANUP SrrF-(NON-LOP) ILITY 173DAIRY <br /> [� UNDERGROUND TANK(MONiTORINGIREMOVAL} ❑ DOG KENNEL D PKG TREATMENT PLANT <br /> O HAZARDOUS WASTE GENERATOR R CHICKEN RANCH El PUMPER TRUCK/YARDIGHEM TOILETS <br /> 13 TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ LAND USE APPLICATION SITES <br /> 13TATTOO/SODY PEIRCING 0 PBLIC LO OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY List <br /> PUBLIC WATER SYSTEM W <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 (209L464-0138 or mail to the <br /> address indicated gbove. <br /> 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. Anew <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 /> CONFIRMED APPOINTMENT DATE T1ME <br /> DATE CONFIRMED __ PHONE FAX INITIALS <br /> REVIEWED- YES NO REVIEW DATE <br /> EN QO 14 OZ741UU <br /> TOTAL P.02 <br />