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SAN JOARIN COUNTYP'UBLIC HEALTH SEC <br /> ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUL 6 '2001 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> h (209) 468-3420 • <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> M <br /> APPLICANT BUSINESSIAGENCY <br /> ADDRESS 22- o �As��-o <br /> PHONE -2 0 1 -3 C ::a 7761 _rAC S I fV1 I LE <br /> TENTATIVE*APPOINTMENT DATL /7— TIME j <br /> (Please give,7 to 1,0 business days from date of application rvbjWtLai) <br /> 61, 3, <br /> CHEC:KI30XTOEXPEDITE RECZUEST.$� - ofF- PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7- 9 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> A 1) -33o PROGRAM ELEMENTS SEARCH <br /> 1-7200 5. 1taeke. kA- :574 T8Gr e.V <br /> :�_'X <br /> -howls, <br /> e? IR"6P <br /> Q&,- Lk tA ))'-2 Deve 1,$?Mi 45-:&M. <br /> 1=M <br /> LILL <br /> IF= S <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP-SlTE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> XUNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> —HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH CI PKG TREATMENT PLANT <br /> % TIERED PERMITTED FACILITY 0 MiOTEUXOTEL 0 PUMPER TRUCKJYARDICHEM TOILETS <br /> 0 TATTOO/BODY PCIRCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> CJ MiEDICAL WASTE FACILITY 0 P U 13 LI C WATER SYSTEM 0 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) 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 /> approx,��ateiy five business days but no later than tbn (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's actively being worked on by EHD staff may not be immediately available for review. A now <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 /> CONFIRMED APPOINTMENT DATE' TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> AEM 00 14 00107100 - <br />