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SAN JC JUIN COUNTYPUBLIC HEALTH r _RV10ES <br /> VIRONMENTAL HEALTH DIVISi <br /> JUN 0 7 Z001 304 .EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> `-f i `', r;i_i f i (209) 468-3420 3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ 0-7-1L � ' Sha w�� BUSINESS/AGENCY . <br /> ADDRESS I I C A 041-I&. S-T S"TC7CkTOIV A 9 57—D G <br /> PHONE r OL 3 3&6 L FACSIMILE' <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please dive 7 to 10 business days from crate of application submittal) <br /> CHECK BOX Tb EXPEDITE REQUEST-$B7.0 FEE-REQUEST CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OAPPLICANT—. DATE D1 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> P., <br /> f <br /> 3 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND,TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMI7�'ij D FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOIBODY PEIRCING ❑ POOLJSPA ❑ 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 $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 /> CONFERMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED J` YES NO REVIEW DATE <br /> EH 00 14 00107100 <br />