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` SAN JO:..,, IN COUNTYPUBLIC HEALTH SEWCES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 . <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT �) re , \J <br />ADDRESS m_f_ <br />PHONE 9 � 1,I <br />BUSINESS/AGENCY <br />Mac9.s-S� (p <br />FACSIMILE 5-1 Qk _ Z.Z-:-S <br />TENTATIVE* APPOINTMENT DATE" TIME <br />(Please Jie 7 to 10 business days frodate of application sm <br />ubittal) <br />l� , <br />HECK BOX TO,EXPL"DITE REQUEST - $07.00 FEE - REQUEST PROCESSED IN 0 BUSINESS DAYS <br />WC <br />SIGNATURE OF APPLICANT <br />DATE <br />._ FILE ADDRESS <br />THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />� 5 � 3 d�a.c_.:. . �uti S hc. � <br />— <br />fEgE <br />�l3`�3 <br />�-l. t,� a L �d-e-w�p•�.#-- S L-J�-�- <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />J�J UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />Xf UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE" GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY P41RCING ❑ POOUSPA - - ❑ LAND USE APPLICATION SITES <br />O MEDICAL WASTE!. FACILITY ❑ PUBLIC WATE=R 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 apRlicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br />5. "TENTATNE 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 />EH 00 14 00/07700 <br />