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UATL HECf:N /VVi!i � i Y` ^ EHD LOG NumuLR f <br /> SAN Jere, UIN COUNTYPUBLIC HEALTH '"'VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> ' l STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 0(1461 e_�R C_Cd , SUSINESSIAGENCY <br /> ADDRESS 3 <br /> 12 --77 I <br /> ++ <br /> PHONE 1y) JU? ' ZZoD FACSIMILE q[{3 1 -/bq - ZZZZ <br /> TENTATIVE*APPOINTMENT DATE - `/ [ Z- 'TIME 9106 A-M <br /> i <br /> {Please give 7 to 10 business days fro date of application submittal) - <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> ,CG, NATUR'E OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH r <br /> u N Lbe► a6�- a ao <br /> x 3 EI-M �_o b t 3 S 1-.'7 _.l-w 38o a C�! '23(.PO � 2308 <br /> 3t Ei.._H Loot 0 S SI 1 <br /> i E 235 <br /> LM Low 1 1 r n i . z <br /> 10-1 SuAC01- La s t 3 Y:.Z 31 <br /> LcIE -TP.AcY Yes T <br /> 1 o W , Ca 9A„S'Tw 0 e --Vc_Y 3--J-7 C'-0 <br /> L�21 i 4ti r_L,� -T12A c-V s_a L n,�” "`_ <br /> 3b3 LO LNL �� t GENVIRONMENTAL HEALTH DIVISION MYSfSSs' <br /> ROU DT - <br /> UNDE GROUND TANK(UST)CLE NUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY 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 (14) days after recdipt 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 $78.00 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 = l\`t'E,S NO REVIEW DATE <br /> EH 00 14 02114ra0 <br />