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1.-/ —L �OVU i r . Ji, i J.� Isrl L <br /> DATE RECEIVED <br /> SAN JO UIN COUNTYPUBLIC HEALTH 3. "VICES <br /> M/IRONMENTAL HEALTH DIVISIG <br /> 304 EAST WEBER AVENUE,THIRD FLOOR � ✓�� <br /> STOCKTON CA 95202 1 <br /> (209)468-3420 <br /> �. PUBLIC RECORDS RELEASE APPLICATION <br /> � <br /> APPt_ICANT BIJSIilE5SlAGENCY �� <br /> ADDRESS //3147CAW <br /> PHONE %fl?iS�I •�34� r _ FACSIMLL1 <br /> TENTATIVE'APPOINTMENT'DATE TIME <br /> (Please give 7 to 10 business days from date of applic,2don submittal) <br /> CHECK SOX TO EXPEDITE REQUEST-$7 L�QUEST PROCE$Sen IN 3 BUSINESS DAYS II <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS TiiIS SIDE EHD STAFF USE ONLY . <br /> PROGRAM ELEMENTS SEARCH >' <br /> �ZoZ M t.d++1� TocKT� <br /> 140 EASP f <br /> ZZ a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT Cl SOLID WASTE FACILITY <br /> ❑ THER CLEANUP SITE(NON-LOP) d FOOD FACILITY CI SOLID WASTE VEHICLE <br /> I� UNDERGROUND TANK(MONITOR3NGfREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> O HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH C] PKG TREATMENT PLANT <br /> 12 TIERED'PER.MITTED FACILITY ❑ MOTI_LIHOTF-L ❑ PUMPER YRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOLlSPA 0 LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY E3 PUBLIC WATER SYSTEM 0 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 (202).464-0138-or„ Mail tom <br /> address indicated above_ <br /> �Z. 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 /> "J3. 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 avallable_ <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. YES NO REVIEW DATE <br /> EH QR 14 azrzuloo <br /> TOTAL P.02 <br />