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SAN JWU1N COUNTYPUBLIC HEALTH &VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENLIEF,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 4684420 <br /> PUBL�I_C_ JRECORDS RELEASE APPLICATION <br /> APpL1CAN7�QQ�P?�^ ,10.) 9*Z, BUSINESSIAGENCY Cocain <br /> ADDRESS <br /> PHONE 2-+4a C2�;-_, ] —FACSIMILE 4�" �L.�"✓.7'CJ - <br /> TENTATIVE`APPOINTMENTDA �r�oTIME <br /> (Pleasg7o10baysrodatof piiatl�w_ lbomntw4r)tT 3, <br /> �.. <br /> s <br /> CHECK BOX TO EXPEO(TE R-EQUEST,$87.00 FEE-REQUEST PROCESSED IN 3AUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� � DATE 16 Of <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> O e,2 8 -Cry <br /> r ran,l "pre r r - oZ <br /> O - c <br /> 'uO1O o <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT l6 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> 9UNDERGROUND TANK(MONITORINGIREMOVAW ❑ DOG KENNEL 0 DAIRY <br /> P HAZARDOUS WASTE GENERATOR ;5 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 M(ITELIHOTEL 0 PUMPERTRUCKIYARDICHEMTOILLTS <br /> ❑ TATTOOMODY PEIRCING 0 POOt1SPA - 0 LAND USE;APPLICATION SITES <br /> Ar MEDICAL WASTE FACILITY 0 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(2091464-0138 or mail to tbQ <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 tater than ten(10) days after receipt of application_ The tiles <br /> wlll be hold 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 filo 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. Appiicallons received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> GFVIFVJCr1 NKR Nrl ocLn�iu n�rr <br />