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.. LIW IVl.i:U f.iI,LI. <br /> `J ;' ,!,U;i SAN JOA 1lN COUNTYPUBLIC HEALTH SEI ;,,/'CES <br /> T - ) ENVIRONMENTAL- HEALTH DIVISION <br /> JUL _ Z0�1 �( 304 EAST WEBER AVENUE, THIRD FLOOR -� <br /> STOCKTON CA 95202. <br /> 209 468-3420 w <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT C P a 1 +�� BUSINESS/AGENCY '.1V 1 VI f On 'N c`s� <br /> ADDRESS LrneISZ� 1] <br /> PHONE ZD 13 9 6 FACSIMILE 2 0 f 3 _� / 2 2- <br /> TENTATIVE- <br /> `i"ENTATIVE-APPOINTMENT DATE _ 7— / � � � TIME - <br /> (Plcasc Dive 7 to 10 business day from dale of application submittal) <br /> /-7 , <br /> CHECK BOX TO EXPEDITE BEQUEST- F- -RE UE PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7- b rt ) <br /> FILE ADDRESS3 30 'ANIS SIDE EHD STAFF USE ONLY <br /> A)) I���ro y PROGRAM ELEMENTS SEARCH <br /> 1-7200 <br /> re <br /> i I <br /> Gr }� � r�W0.� CraSsRl�ts <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST) CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP,SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINQ1RE:MOVAL) ❑ DOG KENNEL 0 DAIRY <br /> IAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> X TIERED PERMITTED FACILITY Cl MOTELlHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PEIRCING 0 POOLISPA .. " 0 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 types) 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 /> approxiihatcly 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 DATE <br /> tH 00 14 oaruTraa <br />