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SAN JOS UIN COUNTYPUBLIC HEALTH SE 'ICES y <br /> C% E IIRQNMENTAL HEALTH DIVISIO} OOIO�O <br /> y �_ MOC)PY 3(l4 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> f. (203)468-3420 .l�I �. <br /> PUBLIC RECORDS RELEASE APPLI ATI0N <br /> RPPLfGAN �1 SUSINESSIAGENCY t!U Jl & <br /> ADDRESS S- �1 s e (A <br /> •'7 f J :tib ,fir, <br /> PHONE Q —�� FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE (TIME _ _-- � �•., ��r n <br /> (Please give 7 to 0 busirteas days from date of aPpilcatlan submittal) <br /> I <br /> I1F:CK BOX TO EXPEgITE REQU T-$78.00 FEE—REgUE ROCLSSED 114.3 BUSINESS DAYS },' <br /> SIGNATURE OF APPLICANT DATE �os <br /> '� i <br /> II, <br /> FILE ADDRESS <br /> �fi T i <br /> It h 14 I <br /> rl <br /> 111 � CI I h <br /> a '< <br /> Ll <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ii <br /> i ❑ HOUSING ABATEMENT tom,, SOLID WASTE FACILITY <br /> 11NDEr#GftOUND TANK(U5T)+YLC4NUP 517E(LOP) i 0 SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY <br /> IN1nERGROUND TANK(MDNITCRINGIRE M1OVAL) M DOG KENNEL ,} 0. DAIRY <br /> HAZARDOUS WASTE GENERATCR Q CHICKEN RANCH a PKG TREATMENT PLANT <br /> ITIERED PERMITTED FACILITY Q MOTELINOTEL ❑ PUMPER TRUCKiYARIDICIAEM TOkF-Ts <br /> CI I' 171 LAND 115E APPLICATION SITES <br /> TATTQOlgQQY PEIRCING POQLfSPA i, <br /> C7 MEDICA1.WASTE FACILITY n PUI3LIC WATER SYSTr=M �;OTHER LEASE SPECIFY Af30 <br /> k <br /> Fair .61'5 I E Fr <br /> - emD� Qn� <br /> 4. List up to tan 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 iltdi ated above. '� <br /> 2. EHD will notify the applicant if any EHL files exist. Aro appoit toren#f4sr review viii he 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. I? <br /> 3. A file that is actively being worked on by EHL] staff may not b,e immediately available for review_ A new <br /> application may be submitted where 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 $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EI-16 staff. I <br /> 6. Applications received after 3:00 prn will be processed the next business day. <br /> If } <br /> CONFIRMED APPOINTMENT DATE TIMI^ <br /> II <br /> DATE CON1=1RMED PHONE FAX INITIALS <br /> it <br /> REVIEWED YES NO REVIEW DATE i <br /> E"00 14 aua�rao <br /> 3 <br /> f <br /> �1 �I <br />