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ai <br />APPLJ <br />A RESS D <br />SAN Jf IUIN C+OUNTYFUSUC HEALTH /ICES� <br />ENVIRONMENTAL HEALTH DIVIZ14ON <br />304 EAST WESER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 4613-3424 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUS W FSSIAGENCY <br />;�hMIAn & r � , <br />�y ,(f f �7 n �j � [f� Nl AY <br />HOME C 161 �rJt � FACSIMILE �U 9 - 1/ i ( �// Q <br />sl- :tALTH <br />TENTATIVE" APPOINTb1ENT DATE _ r� u TIME <br />(Please give 7 toi business days from date of appficai submittal) �;',+ 1 ' F S <br />TS �3. 7h�`5 1 Para fiaf-, <br />AaLr>'r�d <br />CHECK UOX TO E�XPEDITIZ REQ U-578_t7o FEE - RI_t1 STP OGESSEV IN 3 BU3INESS DAYS <br />SIGNATURE OF APPLICANT DATE n' <br />-36L -73roo <br />O <br />1 <br />FrLE ADORr::Ss <br />d <br />iN <br />n _ I A024 <br />C (`d A <br />0 <br />o.z 1 6 <br />?9So .2 0/ _'239 936T, <br />jA <br />Al <br />! j ZZijo /6 / NqS� x397 a?3o% ?380 ?36 <br />1 l 920 <br />-2 ti2--3 S'0 —73 6 <br />360 <br />303 o3 <br />23o B <br />N !O <br />T� <br />A( <br />0 / i1% /�o0)'t Cly It3�0, �f31o2 2360, 2 3, 230 �3 /60p <br />ENVIRONMENTAL. HEALTH DIVISION FILES C0NT1E7Er% <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) n HOUSING ABATEMENT 0 5OLI0 WAS Ti; FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOL.IU WASTE VEHICLJ- <br />UNDERGROUND TANK (MONITORINGIRI_NLOVAL) o DOG KENNEL ❑ DAiRY <br />HAZAROOUS WASTE GENFRATOP, ❑ CHICKEN RANCH 0 PKG TjZEATir1CNT PLANT Z 2101 <br />❑ TIERED PERMITTED FACILITY 0 MOTELmOTEL G PUMPER TRLICKIYARD1CHEM 7 1 TS <br />M TATTOO/BODY PEIRCING d POOLlSPA Q LAND USE APPLJCATiON SfrE.S <br />C7 MEDICAL WASTL FACILITY n PUBLIC WATER SYSTEM EI OTHER (PLLASE SPECIFY ABOVE) <br />1. fist 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 fle type MUST be seiectod. Fax to (20$) 464-0138 or mall tv the <br />address indicated above. <br />2. END will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately five businsas days but no later than ten (10) days after receipt of application. The files <br />will be held for a nnaximum of five buslness days for review. Appointments should be scheduled <br />accordingly, <br />3. A file that is actively being worked on by EHD staff may not by Immediately available for review. A new <br />application may be submitted when the filo is available" <br />4. Any fila 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 $78.40 deposit priorto review - <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will bo processed the next business day_ <br />f <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED _ PHONE FAX INITIALS <br />REVIEWED YES _ NO REVIEW DATE <br />EH 99 14 GVONtu ` <br />