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SAN JC WIN COUNTYPUBLIC HEALTH 'RVICES LHU LU4 NpMLIFII <br /> _.iVIRONMENTAL HEALTH DIVISI%..I4 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> W <br /> // / 7 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �O ,! 'B"U�SINES�SIIApG�ENCY_ <br /> ADDRESS /&Z Z/,/ -lOOe ANCL� <br /> 7 <br /> PHONE / J5& FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE-REQUEST ROCESSED IN 0 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT �Cz � G' DATE <br /> FILE ADDRESS ��\1 <br /> J <br /> 51 - S l ftST a- f� <br /> o � <br /> FEB 28 2000 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> „2rOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORING/REMOVAL) Cl DOG KENNEL ❑ DAIRY <br /> !0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ 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 /> L <br /> PPOINTMENT DATE TIME <br /> D PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> EH 00 14 01/05100 <br />