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(/nV f1Ai�.�ECEIYEU <br />ADDRESS <br />PHONE <br />SAN Jr '1UIN COUN7YPUBLIC HEALTH S- -VICES <br />"VIRONMENTAL HEALTH DiVISIOI. <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 _ <br />(208) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />SUSINESS/AGENCY <br />FACSIMILE <br />TENTATIVE*APPOINTMI=NT DATE/ ( RL7J t j TIME 'VIJ — GJUI <br />(Please gl�e,��7��to 70 6uslnas days from`A/ate of apptitatlon submltun <br />yq CHECK BOX TO rXPEDiTE RE <br />SIGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH DIVISION FILES NOV —7 ZOU1 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LAP) <br />0 HOUSING ABATEMENT <br />0 SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />O FOOD FACILITY <br />❑ SOLID WA5FE VEHICLE <br />UNDERGROUND YANK (MONfTORINGIREMOVAL) <br />0 DOG KENNEL <br />Q DAIRY <br />HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />O PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />O MOTEUHOTEL <br />0 PUMPER TRUCKIYARDICIIEM TOILETS <br />TATTOOIBOPY PEIRCING <br />❑ POOLfSPA <br />❑ LAND USE APPLICATION SITES <br />In MEDICAL WASTE FACILITY <br />13 PUBLIC WATER SYSTEM <br />O 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 />addross indicated above. <br />2. EMU 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 he -confirmed with EMU 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 INfT1ALS <br />REVIEWED YES NO REVIEW DATE <br />EX 09 14 UJQW6 <br />