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DATEMC&VED SAN JOAG 'N COUNTyPUBLtC HEALTH SERA ES ENNnAONMENTAL HEALTH DIVISION �1 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (200)468-3420 PUBLIC RECORDS RELEASE APPLICATION APPLICANT (,� 1 / �w ADDRESS p /Q�� fu��/DYJt 'Onr; U� +7-�nnLi FACSIMILE EHU'L0 _^ -V L AHR 1 12000 r"NVHf UNM--M _AL'fH 't.i�,+JII, /SERVICES TENTATIVE' APPOINTMENT DATE TIME (Plevse give 7 to 1 D business days from data of appllwtlon cuWnittal) NECK BOX TO EXPEDITE REQUC�nll 0 FEE — REQUEST CESSED IN 7 BUSINESS DAYS 71SIGNATURE OF APPLICANT � e– DATE V 7`— N ❑ MEDICAL I List up to ten addresses In the space above. Select to selected. of files from 9) 4 4-0st 13Bvo bma I to t e the appropriate box(es)• At least one file type MUST be selected. moi' aytldr seated above. 2- EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files wilt be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. A. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. •TENTATIVE appointment dates must be confirmed with EHD Staff. e. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED MN TIME PHONE FAX NO REVIEW DATE INITIALS APR 13 2000 ENVIRONMENTAL HEALTH DIVISION FILES CLEANUP SITE (LOP) HOUSING ABATEMENT ❑ SOLID WASTE FACILITY ❑ SOLID WASTE VEHICLE UND❑ SITE OTHER CLEANUP SITE (NON -LOP) OTHER CLEANUP TANK (MONITORINGJREMOVAL) ❑ FOOD FACILITY C3 DOG KFKNEL O DAIRY ❑ PKG TREATMENT PLANT UNDERGROUND HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ MOTELJHOTEL ❑ PUMPER TRUC?UYARDJCHEM TOILETS TIERED PER1111TrED FACILITY ❑ PEIRCING ❑ POOVSPA ❑ LAND USE APPLICATION SITES ❑ OTHER (PLEASE SPECIFY ABOVE) TATTOOfBODY WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ MEDICAL I List up to ten addresses In the space above. Select to selected. of files from 9) 4 4-0st 13Bvo bma I to t e the appropriate box(es)• At least one file type MUST be selected. moi' aytldr seated above. 2- EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files wilt be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. A. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. •TENTATIVE appointment dates must be confirmed with EHD Staff. e. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED MN TIME PHONE FAX NO REVIEW DATE INITIALS