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SAN JOAQUIN COUNTY <br /> EN)OONMENTAL HEALTH DEPARTT <br /> EAST WEBER AVENUE, THIRD FLOG '�� �r <br /> i U;L 2 1 2003 STOCKTON CA 95202 <br /> 4: j` (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT.!24/ BUSINESSIAGENCY j ;�_ <br /> YLI C- t-' <br /> ADDRESS4Z �7 <br /> & <br /> PHONE LZ' FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> -f�n CHECK BOX TO EXPEDITE REQUEST.$89.0 FEE-RE ESTPROC SED IN 3 BUSINESS DAYS Iq <br /> SIGNATURE OF APPLICANT 7771�7 <br /> DATE ( ' % " <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> 4 PROGRAM ELEMENTS SEARCH C�)l <br /> 11 2 2 <br /> jut <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ,,171 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> P� <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL DAIRY <br /> 1:3 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT o TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOIBODY PEIRCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <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 /> 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 now <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 $89.00 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 Ij q <br /> DATE CONFIRMED �v <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHO 48n2 <br /> W2612003 <br />