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At rVeu <br /> SAN JC -11-11N COUNTYPUBLIC HEALTH SE""ICES J <br /> iVIRONMENTAL HEALTH DIVISION <br /> n / / 304 EAST WEBER AVENUE,THIRD FLOOR <br /> /C Sfj' STOCKTON CA 2 ^ S <br /> (209) 468-3420-3A2U /l✓�t//l/ `,�/[ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCAN BUSINESS/AGENCY , <br /> ADDRESS ) �7 <br /> PHONE ao9) �O1 1QO�7 FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE�� TIME <br /> (Please elve 7Ato 10 bwlnss days from date of applicatlon subcWltal) <br /> yA CHECK Box TO EXPEDITE REGI - 78-0o FEE—RE E P,RRO�C�SSED W 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ���i�(L 91L DATE <br /> FILE ADDRESS <br /> wsoft <br /> 11_ <br /> _ V <br /> e to ct�tof <br /> r . .AB srOde 20kyj <br /> �t ENVIRONMENTAL HEALTH DIVISION FILES NOV -7 2001 <br /> }L UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> {�1[❑p5�[.OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGRdEMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILE-18 <br /> ❑ TATTOOIBOPY PEIRCING ❑ POOLISPA ❑ 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 it any ENO 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 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 /> EH VV 14 Ujffl 0 <br />