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V DATE RE,EIVEO 8 SAN J0U1N COUNTYPUBLIC HEALTHVICES <br /> EHV ' <br /> �• f � ENVIRONMENTAL HEALTH DIVISION <br /> a 304 EAST WE13ER AVENUE, THIRD FLOOR r t, <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATI@l " -g p <br /> APPLICAN <br /> ADDRESS T V CJ �� `Q`��_�.BUSINESS/AGENCY T W <br /> PHONE_ <br /> FACSIMILE <br /> TENTATIVE'APPOINTMENT D®TE .� R(J-,(Zh TIME <br /> (P ea a give to 10 6 me�ays fr m date of a plica[on subm1ttal) <br /> CHECK BOX TO EXPEDITE REQUEST�$87.00 FTEE-REQUES?PSE4�U DAYS <br /> SIGNATURE OF APPLICANT oLu <br /> DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> t <br /> Lf(P /-- <br /> 0 c <br /> o� <br /> /0309 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> u JJt1DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT L°S SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY - 11 SOLID WASTE VEHICLE <br /> d11NDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Crddd WARDOUS WASTE GENERATOR L3 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Lkr TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PdMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODYPEIRCING ❑ POOUSPA GrLAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 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 $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 DATF <br />