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SAN JOAJQ COUNTYPUBLIC HEALTH SERVOS I,I 111; <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WE13ER AVENUE,THIRD FLOUR NiAY <br /> STOCKTON CA 95202 3 0 2001 <br /> (209)468.3420 <br /> PUBLIC, RECORDS RELEASE APPLICATION <br /> APPLICANT �'�" ijC"L 1 AVS fr`R' BUSINESSIAGENCY <br /> ADDRESS- 7tj-71 WI.w E(4- 0;)S <br /> V` FACSIMILE Sf�_ ���_ 64011 <br /> TENTATIVE* D)4TE Q"U(NE, TIME <br /> E' .W47'I't111 __- <br /> (Please M;.e r 7v 10 Cusina days from Wile of application submitedj <br /> llv1TS 3, <br /> CHECK BOX TO EXPEDITEREgUEST-56-00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �d^ _!�'_., DATE <br /> I <br /> FILE ADDRESS 'THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 't•5Gp �fr�Y' _ >t'`_w.�t'___7tL1'��T�YfX.kT�- 3s�g , age I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> tf(, ONCERGROUND TANK(UST)CLEANUP SnE(LOP) ❑ HQUSING A9ATEMENT ❑ SOLID WASTE FACILITY <br /> Ij$gTHER CLEANUP SITE IKON-LOP) ❑ FOOD FACILITY U SOLID WASTE VEHICLE <br /> ,UNDERGROUND TANK(MONrrORING/RETSOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IiAZAR0005 WASTE GENERATOR ` ❑ CHICKEN RANCH ❑ PKG 7RFATMENT PLANT <br /> ❑ mOTELIHOTEL 13 PUMpCri TRVCK/YARDICHEM TOILETS <br /> T1ERE0 PERMITTED FACILITY ❑ LAND USV APPLICATION SITES <br /> ❑ 7A MCA-WA$ODY PEIRCILI P FUDUCPOOLISPA <br /> ❑ MEDICAL WASTE FACILITY ❑ PUB41C WATER SYSTEM ❑ OTHER tPLEASE SPECIFY ABOYE) <br /> 1. List up to ten addresses in the space above. Select the types) of fifes from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. x to 2g )a6a 0138 or mail to the <br /> address indir:atad above. <br /> 2. !1� EHD will notify the applicarit if any EHD files exist. An appointment fur review will be confirmed <br /> 1 approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a mazimumef five buslne-s days for review. Appointments should be scheduled <br /> 1n accordingly. <br /> 3_ t'1 A file that ix actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submjtt6d when the file is available. <br /> 4. Any file not returned in the$ame condition as released will be reorganized by EHD staff at the expense <br /> Of the applicant. Future rrla reviews by the same appticant 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 :00 pm will be processed the next business day. <br /> C IONFIRMED APPOINTMENT DATE TIME <br /> DATE COAIFIRMCO PHONE FAX INITIALS _ .. <br /> I <br />