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_ EHU LOG NUMUEN <br /> SAN JOA1' 'IN COUNTYPUBLIC HEALTH SE' 'ICES <br /> &MRONMENTAL HEALTH DIVISION - <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ( O <br /> STOCKTON CA 95202 l <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY G£e�F1A5£_ ENy�Ror-It�Etitygl_ ir.1C- <br /> ADDRESS tA-67 VwMStft l �vTr -' f3L40 <br /> PHONE "7-o`t' Sc<9 - bZ`I 3 FACSIMILE Zoe- Srg�l -m-Zq S <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICAN " �"""D so. l DATE cDl \Vloo <br /> FILES DREss, <br /> -116{ EAST RANT "r, 120A0 NtA C N <br /> $60 h y 1� t1 N it <br /> �1 N Il <br /> It 1� <br /> Ar— <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ® OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE t <br /> * UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ��lJ�b�-- <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND 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 $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 /> EN 04 14 01AW00 <br />