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SAN JC 'WIN COUNTYPUBLIC HEALTH "2ViCES <br /> _ AVIRONMENTAL HEALTH DIVISIG. . =i � 3 <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASEE APPLICATION <br /> APPLICANT ah � � / / BUSINESSIAGENCCY <br /> ADDRESS <br /> r � 19 J'Aerj �% f r �r—,Jh�j{ �f�, <br /> PHONE J � bf7 G �� FACSIMILE � � / G/ ✓ � ' ,2/ Z <br /> TENTATIVE* APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUESTT $89.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �/' � L ?j' � DATE <br /> FILE ADDRESS - THIS SIDE EHD STAFF USEONLY <br /> PROGRAM ELEMENTS SEARCH <br /> f�� 3S g a9ca <br /> CJ //1 L <br /> Y ! 7 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 171 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> `ETHER CLEANUP SITE (NON-LOP) _ P FOOD FACILITY C3SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE1GENERATOR ❑ CHICKEN RANCH - ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL' ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING - ❑ POOLISPA ❑ 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 $89.00 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ta-n t�nc <br />