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SAN JOIN COUNTYPUBLIC HEALTH ICES <br /> IRONMENTAL HEALTH DIVISISO <br /> `.� 304 EAST WEBER AVENUE, THIRD FLOOR VVVV���V <br /> fdJ STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT J BUSINESSIAGENCY <br /> ADDRESSAzz <br /> PHONE �& 3 — -3 1 O v <br /> 5 FACSIMILE <br /> � / 5•'QO <br /> TENTATIVE"APPOINTMENT DATE H1'yj� Int GIN 13' ME - <br /> (Please give 7 to 10 businessdays from dale or application submittal) <br /> Cl.N i TS 4, ',7/` <br /> CHECK BOX TO EXPEDITE REQUEST- 67 FEE-REQUEST PTC ES D IN�SINESS DAYS / <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1 <br /> al's <br /> - 3ao �2 <br /> ZgLIJ',`�",� (� r �a-�c�P ENVIRONMENTAL HEALTH DIVISION FILES OCT ) 2 2001 <br /> V UNDERGROOUND�ANK(UST)YCAANUP SITE LO <br /> P) .HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> }a UNDERGROUND TANK(MONITORING/REMOVAL) ' ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY 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 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 activdly 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 $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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED. YES NO REVIEW DATE <br /> EH 00 14 0a07100 <br />