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SAN JOSN COUNTYPUBLIC HEALTH SOCES LIIL LUV IUUM11ULk <br /> `f�JVu ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 37 <br /> (209) 468-3420 <br /> A\ PUBLIC RECORDS RELEASE APPLICATION <br /> x APPLICANT 1 -e �� } l '•. BUSINESS/AGENCY <br /> J ADDRESS � � P t'- <br /> PHONE U�� ' f � FACSIMILEMetalved• <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give y to 10 business days from date of application submittal) <br /> alis rS 3 , 41 6- <br /> El CHECK BOX TO EXPEDITE REQUEST-$117,00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> GNATURE OF APPLICANT DATE �L <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH \�\, <br /> 0 V <br /> 1 <br /> 4 <br /> D� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) I HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ElDOG KENNEL ❑ DAIRY <br /> VAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> EI TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 2"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 X,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 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 /> EM 00 14 OW07100 <br />