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I CEfVE� <br />ADDRESS <br />SAN J JUIN COUNTYPUBLIC HEALTH SF--'IICES <br />+,rdVIRONMENTAL HEALTH DIVISIO>.. 7 <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON 95202 <br />(209) 468-3-3 42020 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESSIAGENCY <br />TENTATIVE' APPOINTMENT DATE <br />' (Please $Iva� 7��to t0 buslpasi <br />yet CHECK BOX TO EXPEDITE REQUE - 711-oe FEE—RE <br />SIGNATURE OF APPLICANT <br />TIME <br />'s from date of application subrWilal <br />3/ <br />PROCESSED W 3 BUSINESS DAYS <br />ENVIRONMENTAL HEALTH DIVISION FILES NOV —1 'LUUI <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FAC UTY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND YANK(NONITORINGIREMOVAL) <br />❑ BOB KENNEL <br />O DAIRY <br />HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />❑ PKG TREATMENT PUNT <br />TIERED PERMITTED FACILITY <br />L7 M07ELMOILL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOIBODY PEIRCWG <br />❑ POOLISPA <br />Lt LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM <br />M 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 solected. Fax to (209) 464-0138 or mail to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD isles exist. An appointment for reviewwin 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 maybe 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 INfYLALS <br />REVIEWED YES NO REVIEW DATE <br />EH 09 l+ 01Ad00 <br />