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EHD 4OG NUMHLH <br /> ill L I.GLIvIU <br /> SAN JOUIN COUNTYPUBLIC HEALTH S VICES <br /> L.1 IRONMENTAL HEALTH DIVISIO <br /> Z� 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 1K (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �S7 02111); IF:: PM19: 214 <br /> APPLICANT � �IYOQ 1��p ('�,BpUSINQESSIAGENCY /` (� <br /> ADDRESS <br /> 9�D� ��l�lA/G /Y� �t , J-I l 15 Da� 4a,,8z (� �! 6/10 1 <br /> PHONE 510 - q3q - UOD FACSIMILE <br /> TENTATIVE* <br /> �� lJ ��✓ � - ��� �� <br /> TENTATIVE*APPOINTMENT DATE / TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> .I � fi- <br /> CHECK BOX TO EXPEDITE REQUEST-$8� FEE-REQUEST IN 3 BUSINESS DAYS �� l <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> D 6 . 1,011W P . L) a <br /> 1 <br /> PR <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 13 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> �S <br /> 1 .-OTHER CLEANUP SITE(NON-LOP)UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ DOG KENNEL 13 DAIRY _ <br /> UNDERGROUND TANK(MONITORING/REMOVAL) CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN <br /> 13 PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE <br /> ❑ PUBLICWSPA ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> . ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM <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 $89.00 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 /> n <br /> REVIEWED YES NO REVIEW DATE <br /> -ani-nnc <br />