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I SAN JO*IN COUNTYPUBLIC HEALTH *ICES. <br />ENVIRONMENTAL HEALTH DIVISION _ <br />304 EAST WEBER AVENUE, THIRD FLOOR 17j �/ <br />/ I <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT f '' <br />BUSiNE5S1AGENCY 7tJ�ivlG�rYfC��m LIi► <br />ADDRESS f(- S� <br />PHONE -1006 FACSIMILE <br />TENTATIVE* APPOINTMENT DATE TIME <br />(Please give 7 to 10 business days from date of application submittal) <br />31 <br />CHECK BOX TO EXPEDITE REQUEST - $89.40 FEE — REQUES ROCESSED IN 3 BUSINESS DAYS <br />DATE I 2 <br />SIGNATURE OF APPLICANT <br />FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br />` 1 PROGRAM ELEMENTS SEARCH <br />0-1 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />.a OTHER CLEANUP SITE (NON -LOP) <br />X( UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ TIERED PERMITTED FACILITY <br />❑ TATTOOIBODY PEIRCING <br />❑ MEDICAL WASTE FACILITY <br />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 />EHD 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 />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 />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 $89.00 deposit prior to review. <br />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. J <br />❑ <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />❑ <br />FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />❑ <br />DOG KENNEL <br />❑ DAIRY <br />0 PKG TREATMENT PLANT <br />❑ <br />CHICKEN RANCH <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ <br />MOTELIHOTEL' <br />❑ LAND USE APPLICATION SITES <br />❑ <br />❑ <br />POOLISPA <br />PUBLIC WATER SYSTEM <br />0 OTHER (PLEASE SPECIFY ABOVE) <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED <br />62 -- <br />YES j NO <br />2-/0 �- TIME <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />