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Ui/b_//2062 16:Lis 2094671 GuL S(UCKTU i <br /> } u, laic rccuuvtu EHD LOG NUMBER <br /> SAN JOA IN COUNTYPUBL.IC HEALTH SE . ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> J 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 �Jf3 <br /> PUBLIC RECORDS RELEASE APPLICATION / <br /> APPLICAN1. aoo) <br /> BUSINESS/AGENCYNmed d/ I <br /> ADDRESS Lo <br /> PHONE V�4t 1Xk lF CSIMILE / 7/// <br /> TENTATIVE*APPOINTMENT DATE_` ; TIME /4�- EL <br /> (Please give 7 to 1 business days from date of applicatlon submittal) <br /> �i TS 31 <br /> CHECK BOX TO EXPEDITE RFQU $78.00 FEE—RE U ST PR CESSED IN 3 BUSINESS DAYS <br /> /4\ <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS O <br /> r- •) i <br /> s <br /> Z3/- <br /> U <br /> �f r► <br /> n <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM-TOILETS <br /> ❑ TATTOOI90DY PEIRCING 0 POOL/SPA CI LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY CI PUBLIC WATER SYSTEM ❑ OTHER(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 feast one file type MUST be selected. Fax to (2Q91464-0138 yr MAll t9-the <br /> address indicated p�qvQ, <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$78.00 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 /> FJ4 00 14 ovosroa <br />