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II It. uw um iw.x,u. <br /> ILI li SAN JOA . . N COUNTYPUBLIC HEALTH SEf�CES <br /> ENVIRONMENTAL HEALTH DIVISION Cc <br /> JUL - 6 Zoll 304 EAST WEBER AVENUE,THIRD FLOOR �J <br /> STOCKTON CA 95202 <br /> � LTH; (209) 468-3420 ° <br /> E�ubIRJi'JiJ�E��; _- <br /> —� �;F� PUBLIC RECORDS RELEASE APPLICATION ) <br /> APPLICANT CLIP W w� BUSINESSIAGENCY �y�D /•'I '9 q w1ron W`c'rir, <br /> ADDRESS ZZ 0, HO\$ko.n LQn,4 Loll cfI ^ 5-21-) 17 / <br /> PHONE 2 o 9 . 3 6� —3 761 FACSIMILE ✓�7 � 0 / 4 9 — Z/2 r2A . �C <br /> TENTATIVE*APPOINTMENT DATE �— / / Z�0 ) TIME C: _ <br /> (Please vivo 7 to 10 business days from dale o(application submittal) <br /> /T 5- 3, 51- <br /> F7 CHECK BOX TO EXPEDITE REQUEST-$ F -RE UE PROCESSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 7- 9269) <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> R1) }�,a 330 PROGRAM ELEMENTS SEARCH <br /> 7200 5. 1 Toe <br /> Q S', 'r-A, Car e.�a-<'.rC l� ani <br /> 0&\tZA N i I <br /> J;L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP-SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> X TIERED PERMITTED FACILITY - ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY P81RCING ❑ POOL/SPA "' ❑ 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 /> approxiinately 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 thatis 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 />