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SAN JC&UIN COUNTYPUBLIC HEALTH SI01ICES f"nLOG'UU11 ( 'V 1.1— <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 / <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION jr <br /> APPLICANT , , —. u / BUSINExSOENCY <br /> ADDRESS nU / � <br /> /14 7- <br /> PHONE VdP— Z,-3 g <br /> FACSIMILE 95��'-D/vZ I <br /> TENTATIVE'APPOINTMENT DATE TIME ,— O <br /> (Please give T to 10 business days from datc of appliWion aubmltW) <br /> CHECK BOX TO EXPEDITE REQU ST-$78.00 FEE-REQUEST PROCESSED W 3 BUSINESS DAYS O <br /> SI TUBE OF APPLICA { � 1 <br /> DATE <br /> FILE ADDRESS • _ <br /> C — y . .0 414 •-IVB <br /> US o — aI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> CLF <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOU31NO ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY Q SOLID WASTE FACVeHILIT <br /> ,� }1NOEROROUND TANK(MONITORINOlREf80VAl) O DOG KENNEL ❑ DAIRY <br /> ¢-HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 1� TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKrYAROICHEM TOILETS <br /> ❑ TATTOoicopy PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM In OTHER(PLE"E sPHGFY ABOVE) <br /> �. List up to ten addresses in the Space above. Select the type(s)of files If the list abov by checking <br /> the appropriate box(es). At least one Tile type MUST be selected. Fax Co(209)464-0L3 or mall to thg <br /> address Indicated above T - <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment f/or review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> accordingly. <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew <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 EHU staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require A$78.00 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, y� <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO <br /> w a �. argvoo REVIEW DATE <br /> TOTAL P.02 <br /> 1 <br />