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} , SAN JOARIN COUNTYPUBLIC HEALTH SAICES <br /> ENVIRONMENTAL HEALTH DIVISION ] — <br /> �' 304 EAST WEBER AVENUE, THIRD FLOOR y <br /> / STOCKTON CA 95202 <br /> (209) 468-3420 . <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r �^'� BUSINL=SSIAGENCY <br /> ADDRESS QA <br /> PHONE �� LZZ( FACSIMILE" <br /> TENTAl IVE"APPOINTMENT DATE TIME <br /> (Please ui c 7L 90 business days from date of application submillal) <br /> A)/7,5 3, ,/ <br /> HECK BOX TO,L=XPEDITE REQUEST-$37.00 FEE—REQUEST PROCESSED IN 3 BUSINE=SS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> FILL ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM E=LEMENTS SEARCH <br /> mn fpc <br /> 'J <br /> -z — <br /> y��� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Z/UNDERGROUND TANK(UST) CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEI-IICLE <br /> )� UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE= GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ PAO-rEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY POiRCING ❑ POOUSPA - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE= FACILITY ❑ PUBLIC WATE=R SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tcn addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(cs). At least one file type MUST be selected. Fax to (2.09) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointrnent 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 apRlicant. Future file reviews by the same applicant may require a $117.00 deposit prior to review. <br /> 5. *TENTAT.tVE 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 c YES NO REVIEW DATE <br /> EH 00 14 OG107100 <br />