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U,,'' RCGIiVLU rl UW W,11 kWL1l <br /> ��AN JOAON COUNTYPUBLIC HEALTH SE•CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JAN O 5 Luul 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> cl; iRONMENT HEALTH (209) 468-3420 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT DOIQ C 1-( r—:-5N Ex BUSINESSIAGENCY <br /> ADDRESS P 0 BOX :3_7'�1 4 IX F,i.00-fL <br /> PHONE 'Y! — 4"O FACSIMILE /n/�' Yl '�✓`�%� <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-67 FEE g— T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Z ' DATE / O <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH LV <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL - 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 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 f209) 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 $87.00 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 00 14 08/07/00 <br />