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SAN JO UIN COUNTYPUBLIC HEALTH & JIGS <br /> I NVIRONMENTAL HEALTH DIVISION- <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> G j Si'OCKTON CA 95202 <br /> fC (203) 468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION_ <br /> APPLICANT" �Q� PZ.. BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE; �1 FACSIMILE r � <br /> TNrATrv =, Pol�crr�>=N, oar t T„4E 10 <br /> (Pleases give 7 to 10 b css ayes fr ru date of plication suEmttial) 71�r7 <br /> QJECK BOX TO EXPLnITE PLQUEST-$87.00 FEE—REQUEST PROCESSED IN3 BUSINESS DAYS <br /> 51GNATURE OF APPLICANT DATE 01 <br /> FILE ADDRESS THIS SIDE EHD STAEf USE ONLY <br /> d PROGRAM ELEMENTS SEARCH <br /> r�".I Prs�K r 111= <br /> (O 1 O <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOT]FACILITY ❑ SOLID WASTE VEHICLE <br /> Pj UNDERGROUND TANK(MONITQRING/RFMQVAL.) 0 DOG KENNEL. CJ DAIRY <br /> 10 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> EI TiERETJPEftMiTTEDFACILITY 0 WTELIHOTEL 0 PUMPER TRUCKIYARDICHEMTOILE I'S <br /> 1:7 TATTOOISODY PEtRCING 0 POOLISPA - - 0 LANb USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY CI PUBLIC WATER SYSTEM 0 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 f209) 464-0138 or mail to the <br /> addM*tindicated above. <br /> 2. EHD will notify the applicant if.any EHO 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 hold for a inaxlmum 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 riot returnud in the same coriditivn 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 /> f CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> I AF1/fFtAl>=rl 1/t=C <br /> Kin nA-rr <br />