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SAN JC ZUIN COUNTYPUBLIC HEALTH S^RVICES LNULUGNUMULH 1)/ <br /> `L!AVIRONMENTAL HEALTH DIVISIC,..,.,, <br /> 304 EAST WEBER AVENUE,THIRD FLOOR �- <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT V�,MAIXD VACS O�j BUSINESS/AGENCYy'•O���1 .5E E^IVI��'�CJ TK I`y <br /> ADDRESS 2 a1 zi -7 \j(AA c-vv1 c-vt N%JC *r i5 Z-'I <br /> PHONE Z-09 t5bq 01-f!3 FACSIMILE..' apt 5 (99 a�`� `� 00/065 <br /> TENTATIVE"APPOINTMENT DATE MA'I�N f01 _L0C7C3 TIME <br /> (Please Hive 7 to 10 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`^ .��u�� �tk 1,3 cv J DATE 0±j0-7100 <br /> FILE ADDRESS <br /> Int 5�--v�►L-t--n�•l <br /> �Ls 5\�Fw ^Z�ca Lw C44�Q-c>•<'P- W - S.� <br /> "Sx�FGv.t:f t t t�ltn•� ZAc �AE.M 5 <br /> 1111 rJAV Y D21 V -a a;k4vZ-rv/ l:J <br /> l STOP loot Or \OL\cj 1-1 9-T_♦V— S oc L' Yom. <br /> -t"."S"'t..l o nJ srar� 515 w, c.\-�A R�Is� <br /> NAVY V0 5 �Y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> IR OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> N UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ 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 /> E <br /> RMED APPOINTMENT DATE TIME <br /> ONFIRMED PHONE FAX INITIALS <br /> ED YES NO REVIEW DATE <br /> EH 00 14 01/05/00 <br />