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EHD LOG NUMBER <br /> GATE RECEIVED <br /> RECEu V LSD SAN JOAL. l�,; N COUNTYPUBLIC HEALTH SES . ICES <br /> D ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> NOV 0 3 2000 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENVIRONMENT HEALTH oPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT C /� � t L BUSINESSIAGENCY <br /> iD 1= v a :dco r i <br /> ADDRESS <br /> PHONE 1 y FACSIMILE <br /> TENTA IVE* AP 91N MENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUE�SJT - $87.00 FEE — REQUE T PROCEj5SED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT ZL/ .tw,rDATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Q _ if <br /> i <br /> 6L7C4:90 <br /> I <br /> tji <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> fB" UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 13SOLID WASTE FACILITY <br /> GYOTHER CLEANUP SITE (NON•LOP) ❑ FOOD FACILITY - ❑ SOLID WASTE VEHICLE <br /> litUNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL - ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 13MOTELIHOTEL 13 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA 1:1LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 13OTHER (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 applicant. Future file 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 /> I � <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I DATE CONFIRMED PHONE FAX INITIALS <br /> i <br />�- REVIEWED YES NO REVIEW DATE <br />