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uJ\I t nitcwcu Ulu I.Lb Nu;u!,A <br /> SAN JOA AN COUNTYPUSLIC HEALTH SE 'ICES (l <br /> ENVIRONMENTAL HEALTH DIVISION' l <br /> (04+ 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT IA1614,46L MCZIt/E'TrE BUSINESSIAGENCY CoNaoli- E6911 j��'GItrJ�+Lo Qyld� <br /> ADDRESS 1:RA NK WC,,-I- Cj�GL.bY 5vfi'E�"r ST'o cY-tam GAC) fo <br /> PHONE 2'b'4-0578 FACSIMILE 2 3 4 - <br /> / / <br /> TENTATIVE'APPOINTMENT DATE /D,/ (f,� /y,00! TIME A1.c�✓.��.w . <br /> (PI"m;give T to 10 husineas days froJn date of[ap NQ tlm submittal) <br /> ..'r/r✓1 T ?,, -/ <br /> CHECK BOX TO EXPEAITE REQUEST-$a7.00 FEE-REQUEST PROCESSEn IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �`^ � � DATE J + + t <br /> I"ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> 0 S- S7 - N G O A D <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> �111JER CLEANUP SITE(MON-LOP) ❑ FOOD FACILITY G SOLJD WASTE VEHICLE <br /> W-TWERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IQ�HAZAROOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOIEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑��jATTOOIBODY PEIRCING iiPOOUSPA ❑ LAND USE APPLICATION SITES <br /> Ix MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton 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)46"138 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 confimied <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be hold 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 /> S. "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 /> nFl/IF18/Cr\ vtc un <br />