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SAN JOA�, .jlN COUNTYPUBLIC HEALTH SERA : ES <br /> I ENVIRONMENTAL HEALTH DIVI ON <br /> 3 , 4 EAST WEBER AVENUE, THIRD L <br /> STOCKTON CA 95202 <br /> - i (209) 468-3420 <br /> * q PUBLI 'CII RECORDS RELEASE PPLICA ION <br /> APPLICANT Ill.ll I � 0. MtL) BUSINESS/AGENCY - 4FZ,11J <br /> ADDRESS /UGk �/!' /j�� ) �/J <br /> PHONI�D� SJ j�� _ / d7(Y it FACSIMILED <br /> TENTATIVE' APPOINTMENT DATE TIME <br /> (Please, Oi;vo 7 to 10 business days from dato of application submittal) <br /> 4W/ r-5 3 atice gr <br /> CHECK BOX TO EXPEDITE REQUEST - $87,00 F E - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� DATE <br /> FILE ADDRESSTHIS SIDE EHD STAFF USE ONLY <br /> S. <br /> �' D-U PROGRAM ELEMENTS SEARCH <br /> I - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑. TIERED PERMITTED FACWTY In MOTELIHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING G POOIJSPA % ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY - O PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFYABOVE) <br /> 1 . List up to ten addresses in She space above . Select the type(s) of files from tha list above by checking <br /> the appropriate bOX(es). Ai, 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 applicant. Future fill reviews by the same applicant may require a $87.00 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 /> CW PA we <br /> - TOTAL P , 01 <br />