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LI lU LUU NUMULK <br /> SAN JOAUN COUNTYPUBLIC HEALTH SEWC ES <br /> �} r` ENVIRONMENTAL HEALTH DIVISION { ,r <br /> 304 EAST WEBER AVENUE, THIRD FLOOR 'F' � ' N <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIONFp <br /> vp <br /> APPLICANT <br /> - BUSINESSIAGENCY I 1 ' ( u <br /> ADDRESS <br /> r <br /> PHONE FACSIMILE X' <br /> r:-• :... _ <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> r;<'�CHECK'BOX TO EXPEDITE REQUEST-$87.00 FEE=REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> .�w..vtz,�-�se'\ 4 I- y}�� !;n'c.' ;r r ?" r r ~ i'•t V <br /> ^u .rnf. a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ITER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> N ERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOISODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ID MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I 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 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 /> i <br /> DATE CONFIRMED PHONE FAX ' INITIALS <br /> REVIEWED YES NO REVIEW DATE ' <br /> EH 00 14 03107100 <br />