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J.� SAN J UIN COUNTYPUBLIC HEALTH WICES IRONMENTAL HEALTH DIVISI 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 (209) 468-3420 PUBLIC RECORDS RELEASE APPLICATION APPLICANT / g rQ �f BUSINESS/AGENCY / �'^� h, ✓� -� ADDRESS PHONE - r�_ >) 6; F --7G FACSIMILE ✓.2 J1 e,, Ss- - - ->- Z =F( /-137 TENTATIVE' APPOINTMENT DATE TIME (Please give 7 to 10 business days from date of application submittal) e 61 W,/ %5' 2, 4- � CHECK BOX TO EXPEDITE REQUEST - $89.00 F E (f -REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT �/� /�`?j'� DATE FILE ADDRESS THIS SIDE EHD STAFF USE ONLY PROGRAM ELEMENTS SEARCH HOUSING ABATEMENT ElSOLID WASTE FACILITY 02/ G (Nr Gl r><er ❑ FOOD FACILITY Y! S. < ft��/ r WASTE VEHICLE El UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL C3DAIRY ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT - ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL- ❑ PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) ENVIRONMENTAL HEALTH DIVISION FILES WL TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ElSOLID WASTE FACILITY UNDERGROUND THEIRCLEANUP SITE (NON -LOP) ❑ FOOD FACILITY 13SOLID WASTE VEHICLE El UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL C3DAIRY ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT - ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL- ❑ PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated 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 will 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. 4. Any file not returned 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 $89.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED REVIEWED YES NO TIME TIME PHONE FAX INITIALS REVIEW DATE