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i <br /> I L! <br /> SAN JOA 1N COUNTYPUBLIC HEALTH SE ICES ! <br /> CENVIRONMENTAL HEALTH DIVISION f- E <br /> �J 4� 304 EAST WEBER AVENUE, THIRD FLOOR <br /> d <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1 '�' �` E3USINESSIAGENCY C ' <br /> ADDRESS L (V`� 5� �A <br /> PFIONE 1 ` �'�Z( FACSIMILE _Ci_u <br /> TENTATIVE"APPOINTMENT DATE J- TIME <br /> (Please d, c 7``to10 bu'rincss days from dafo of Spptication submittal) <br /> 7-S <br /> CHECK BOX TO,L•XPEDITE REQUEST-$117.00 FEE=REQUEST PROCESSED 1N 5 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I <br /> _ FILE ADDRESS ;j" THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> kNV-► <br /> I Ca 5�Z 7 o-t y � <br /> l 't._31Z AV,4_ <br /> ENVIRbNMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST) CLEANUP SITE(LOP) P0e HOUSING ABATEMENT' ❑ 50LID WASTE FACILITY <br /> OTHER CLEANUP SITE(MON-LOP) -❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR .❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑. MOTELIHOTEL ❑ PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑ TATrOOIBODY P41RCING 'CI POOLJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MCDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> I. List up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(cs). 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 day's-`.but no later than ton (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 $87.00 deposit prior to review. <br /> 5. "TENTA7t`VE 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 /> I <br /> DATE CONFIRMED PHONE FAX INITIALS s <br /> REVIEWED YES NO .i REVIEW DATE <br /> LH 00 $4 04167100 --- <br />