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U% <br /> SAN JOAO*,,,y COUNTYPUBLIC.HEALTH SERV <br /> CESLill:iVl,is UPn if- <br /> y� ENVIRONMENTAL HEALTH DIVISION <br /> " ( 304 EAST WEBER AVENUE, THIRD FLOOR <br /> J STOCKTON CA 95202 G �� <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> T / <br /> ;PPLICANT tr�l C— JWAr 110_ <br /> 77 BUSINESS/AGENCY S��f <br /> tDDRESS G� UOQ Com <br /> ll s <br /> HONE JZa`1) V`— 5177-3 <br /> �— FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE <br /> Please TIME <br /> ( give 7-to 10 business days from dta,.t Ofof application submittal) <br /> CHECK BOX TO EXPEDITE`REQUEST-$ REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 1GNATURE OF APPLICANT <br /> DATE <br /> FILE ADDRESS --- _. <br /> THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> i <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 ❑ <br /> SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) C3DOG KENNEL ❑ <br /> DAIRY <br /> HAZARDOUS WASTE GENERATOR IDCHICKEN RANCH ❑ <br /> TIERED PERMITTED FACILITY ❑ PKG TREATMENT PLANT <br /> 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 /> 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 /> 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 /> 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 /> 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 /> "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed the next business day. <br /> ONFIRMED APPOINTMENT DATE TIME <br /> aTE CONFIRMED PHONE FAX <br /> INITIALS <br /> -VIEWED <br /> YES NO REVIEW DATE ' <br /> 00 14 00i07100 <br />