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Ulu Lug,f111 i.iL;Li. <br /> SAN J(, QUIN COUNTYPUBLI HEALTH S'-_..?'VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR Z 9 2001 304 EAST WEBER AVENUE THIRD FLOOR <br /> STOCKTON CA S5202 <br /> ENV1 ;C'NIM HE.LTf-1 (209) 468-3420 <br /> PEFij .iI/SER'ViCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_,Z!HM',tl'1) �-fZkA�C'SA(U BUSINESSIAGENCY <br /> ADDRESS �/=7 `f'x <br /> PHONE 2u '- CJjS L{ FACSIMILE Zv <br /> TENTATIVE" APPOINTMENT DATE TIME <br /> (Please dive 7 to 10 business days from d to of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-SB7.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS J <br /> SIGNATURE OF APPLICANT ��� DATE ICP— 2-' ` <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 11NDERGROUND TANK(UST)CLEANUP SITE(LOP) ,❑ OUSING ABATE MENT ❑ SOLID WASTE FACILITY <br /> THEIR CLEANUP SITE(NON-LOP) FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR C3CHICKEN RANO Q PKG TREATMENT PLANT <br /> HT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOIISPA ❑ LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY ❑ PUBLIC WATER YSTEM O 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 $87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmedwith 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 EVIEW DATE <br /> rm 00 14 08!07100 <br />