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SAN JC ;U1N COUNTYPUBLIC HEALTH SF 'ICES <br /> EKVIRONMENTAL HEALTH DIVISIOi9-1*' 00/O�O <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209}468-342D <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAN Z[trI BUSINE53/AGENCY <br /> rJu , <br /> y 5- Gt117s a c CA soros- o� <br /> ADDRESS p91 / rl <br /> PHONE Q 'IO FACSIMILE <br /> TENTATIVE'APPOINTMENT BATE TIME \�P"a . - <br /> (Please give 7 to 10 business daya from date of appllrallan submittal) ! <br /> HECK BOX TO EXPEDITE REQU T-S78.00FEE—REQUE ROCESSED IN 3 BUSINESS DAYS •,.t7. <br /> SIGNATURE OF APPLICANT DATE 3 Io Qi' <br /> FILE ADDRESS w x JS Cam' <br /> -j pti,C IS ss-, � <br /> T <br /> It n tl <br /> 11 It t <br /> II tI II <br /> em6 Ma <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT n SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONRORINGIREMOVALI ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOtaODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ?,-OTHER LEASE SPECIFY ABO <br /> Ear VM <br /> 131 E-Re"ft- On� <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. Appolntrnents should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available forreview. 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 /> S. `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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS !!! <br /> REVIEWED YES NO REVIEW DATE <br /> ex oa a Hia�no <br />