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DATE- RECEIVED EHD LOG NUMBER <br /> SAN JOAt.., IN COUNTYPUBLIC HEALTH SE . , ICES <br /> I DDCD � WU CSD ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> NOV 0 3 2000 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ENVIRONMENT HEALTH JPUBLIC RECORDS RELEASE APPLICATION ` / <br /> APPLICANT G�/.0 � L BUSINESS/AGENCY �!"C �LL[irC 4IZt- C(� <br /> ADDRESSk dee/ Z f <br /> PHONE Ij � y FACSIMILE <br /> (� 3 (j` <br /> TENTA IVE* AP OINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQU E�S� - $87.00 FEE — REQUE 7 PROCETSSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��L_�'e / t _ DATE �� �� -� C <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 10 c J 3 (r L l� <br /> I <br />:I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> :: OTHER <br /> TANK (UST) CLEANUP SITE (LOP) 13 HOUSING ABATEMENT 1:1 SOLID WASTE FACILITY <br /> :: OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> GUNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR E3CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 11 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL C3 PUMPER TRUCK/YARD/CHEM TOILETS <br /> CI TATTOO/BODY PEIRCING 13POOLISPA 11LAND 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. Anew <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 /> rREVIEWED <br /> FIRMED APPOINTMENT DATE TIME <br /> CONFIRMED PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> EH 00 14 08101100 <br />