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SAN JOl "`UIN COUNTYPUBLIC HEALTH SF-VICES <br /> @�NIRONMENTAL HEALTH DIVISION 3 '7 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTr�77Lq" Qr42-r— BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE (l f_ '_ �o S "-7G �/ FACSIMILE S / z �J ✓} ^ 7/ Z _'6 <br /> TENTATIVE'APPOINTMENT DATE TIME - <br /> (Please give 7 tto�10 business days from date of application submittal) • <br /> CHECK BOX TO EXPEDITE REQUEST-$89 0 F E-REQUEST ROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS - THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> G W, If <br /> J✓ (7 S, �<1iw ri�c n 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> *NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT , <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL' ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA Cl 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$89.00 deposit prior to review. <br /> S. '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 /> Xa11dUe <br />