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SHO TUG NUNi3�F{ <br /> SAN JO JUIN COUNTYPUBL.IC HEALTH S" "ICESj� <br /> L_ _JIRONMENTAL HEALTH DIVISIO,. <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> 00 r: <br /> STOCKTON CA 95202 �2 7 2001 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATIpf�l`0i"O I'vii ,V h1f: h' <br /> APPLICANT Q Q BUSiNES51AGENCY 1 <br /> ADDRESS <br /> PHONE FACSIMILE <br /> TENTATIVE*APPOINT16ENT DATE TIME <br /> (Please dive 7 t4 10 business clays from date of application submittal) LUG I <br /> CHECK BOX TO ECPJ_DR c REQUEST-$$7,00 FEE-R.EQUEST PROGESSLU IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 0d'A0`r%1Q LyL1_trarL&rJ DATA 3-W-7-01 ' <br /> FILE AQDI2ESS THUSE <br /> PROGRAM ELEMENTS S <br /> 5 Pd h, 8 <br /> + o� ? <br /> n - ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST}CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FAG11M <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FQCIL.TTY ❑ SOUE)WASTE VEHICLE <br /> UNUERGROUND TANK(M0NITORI14G4tL_MOVAL) 0 DOG KENNEL ❑ DAIRY <br /> ;�i"HAZARDOUS WASTE GENERATOR D CHICKEN RANCH Q PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL © PUMPER TRUCKrYARDICHEM TOILETS <br /> CI TATTOOMODY PEIRCUIG ID POOLJSPA .2q_LAND USE APPLICATION StTI_S <br /> O MEDICAL YYASTI:FACILITY ?1113,1.1C_WATF.R,X§ff.U:;. d 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 feast one fila type MUST be selected. Fax to(209) 46"138 or mail to th <br /> address indicated abpve_ <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 far a maximum of five business days for rev-sew. 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 nut 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 $81.00 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 clay. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX IN171At_S <br /> RFVIFLVI=n Rr-Usi`w nAYr <br />