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DATE RECEIVEDi <br /> SAN Jr UIN CDUNTYPUBLIC HEALTH ' VICES <br /> iIVIRONMENTAL HEALTH DIVISIC <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 1 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> BUSINESSIAGENCY <br /> ADDRESS 3Y7 <br /> r-AGSIMILrm <br /> TIME <br /> TENTATIVE"APPOINTMENT DATE <br /> (Please give T to 10 business days from date of application submittal} <br /> CHECK BOX TO EXPEDITE REQUEST- 7 EQUEST PROCESSED IN 3 BUSINESS RAYS <br /> 1 <br /> DATE /Z Z�Zoe <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS 'PHIS SIDE EHD STAFF USF_ONLY � <br /> PROGRAM ELEMENTS SEARCH <br /> . � LRS <br /> 6 f �ST Mf <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M"'rUNDERGROUND TANK(UST)CLEANUP Srl�(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACIUTY <br /> Q THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY CI 50LID WASTE VEHICLE <br /> E UN[7ERGROI ND TANK(MONiTORiNGIREMOVAL) ❑ DOG KENNEL a DAIRY <br /> O HAZARDOUS WASTE GENERATOR A CHICKEN RANCH O PKG TREATMENT PLAKT <br /> ❑ TIERED PER.YIITTED FACILITY El MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATT00113ODY PEIRCING ❑ POOUSPA 0 LAND USE APPLICATION SITES <br /> C] 14EDICAL WASTE rACILITY 0 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type($) of files from the fist above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 454-0138 or mail to tile <br /> III 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 /> wilt be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. Afile 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$78.40 deposit prior to raview. <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 INiTLALS <br /> REVIEWED. YES NO REVIEW DATE <br /> EH Oa to 0=4100 <br /> TOTAL P.02 <br />