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DATE REr.EIVEO eEW <br /> SAN J�.11N COUNTYPUBLIC HEALTH�VICES � <br /> y ENVIRONMENTAL HEALTH DIVISION <br /> t.6304 EA TWE 3ER AVENUE,THI,�I FLOOR ?• <br /> STOCKTON CA 95202,: <br /> (209) 468-3420 L Q ✓ "��' `-0 <br /> �- PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q�0.'�- GL*`l��1 n e_�BUSINESSIAGENCY CXX <br /> ADDRESS <br /> PHONE `S - �� FA-CyS—IMILE L Y r MAY 2 8 2002 <br /> TENTATIVE*APPOINTMENT DATE L1 t )n CL O Z TIME '�7 A. /1-RUVIRONMENT HEALTH _ <br /> (Please give 7 a 10 iness s fro to of tion su mittal) ` PERMIT/SERVICES <br /> CHECK BOX TO EXPEDITE REDOES -$87.0 FEE EQUEST PROCESSE IN NES AYS <br /> SIGNATURE OF APPLICANT a C DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 3 <br /> r <br /> ti <br /> AJ Jon, <br /> I � <br /> r2 it <br /> n <br /> reLc <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT 91, SOLID WASTE FACILITY <br /> OTHER 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 ❑ MOTELJHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODYPEIRCING ❑ POOLJSPA "- ❑ LAND USE APPLICATION SITES <br /> W 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 />