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L1IULU6NUMHLN / i _ / <br /> SAN JC JUIN COUNTYPUBLIC HEALTH c 3VICES ( (/� <br /> " , AVIRONMENTAL HEALTH DIVISIL <br /> 304 EAST WEBER AVENUE, THIRD FLOOR y� <br /> STOCKTON CA 95202 Y tX- n <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT P10NA11D C Aws O �U BUSINESSIAGENCY G£o I711A5E E�V '�ROI-t A'�.�I�TA L 1 N L . <br /> ADDRESS 7 Ve.v«vnaK 1k ` iSZ t (Not •�`� CZa CAN 1 :a35G <br /> PHONE I 5 ( I OZ93 FACSIMILE c+a• per( 5 & 9 612r � 00 / 065 <br /> TENTATIVE" APPOINTMENT DATE MM�-� 101 "LOOC7 TIME <br /> (Please give 7 to 70 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST - $78.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��3 DATE of 7 OL7 <br /> FILE ADDRESS <br /> 10 j <br /> sW IFT Ar.ls[orLr 7 £31 5W wTVi `ter ribi V 1+ a uA 60 7, 14 3 a AA ko <br /> 1 t5 SiA LCA Z.(? Lu CNd.QTE� W 5.�2. <br /> COLO MAO ITGt$GAwJA 14c1 5 , L% 0CVULl wAl 3s-,�, (� — <br /> SnGt� 7 t�l�a. r zAc FAEMS fill WAVY D2.iver: roil 35� W W <br /> vE oLr -r2VcK5Tvp I661 0, rovS A M� � 3S <br /> -rrGA1J5 •ly' • '. '-, 1onJGN +A (2�T'6t2 ✓ $ •� �• <br /> `i ' 9 W , C %A 2� V� � a cT <br /> r ft 1� V�&T f S Ti< MyK X12- ZS NAV OIZ <br /> EEL= <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> & OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> IH UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> OF HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARO/CHEM TOILETS <br /> ❑ TATTOOIBODY 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 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 $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. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01105/00 <br />