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Jou; SAN J IN COUNTYPUBLIC HEALTH VICES <br /> RONMENTAL HEALTH DIVISI Y <br /> 51F E B 6 6 24 AST WEBER AVENUE`,THIRD FLOOR <br /> STOCKTON CA 95202 RV <br /> EAVIRUN SENT E BALI H (209)468-3420 _ <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT-DAV 1-0 VP C_CA Z&-Z-'z-41 BUSINESS/AGENCY <br /> ADDRESS p c , o Zi 5" <br /> PHONE X09 481 7 (093 FACSIMILE 2`�/ 36? �7�3 <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> ) Z <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE—R EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ` DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> E1V7_t? 12 V t c GCS��i 5 Z�'t Gv�11 �► 2 " <br /> .fou,o �- <br /> �OC�{ D .4 / <br /> Z-06/_,' <br /> h/3 ek)A5 r-0-2'Aet'v e4. /6FM0V'4L c� <br /> R, 0q 000 <br /> ENVIRONMENTAL HEALTH DIVISION FILES W-O5 <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT OLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ MO EUHOTEL RANCH0 CHICKEN 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA <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(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 EMD 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 returnee) 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. <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 /> _A fit-not, <br />