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UA�rF��iECEN§n jl. ii.� � fJ�G LUo rvaltl6EN <br /> SAN JO UIN COUNTYPUBLIC HEALTH SER..CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AUG 1 3 2001 304 EAST WEBER AVENUE,THIRD FLOOR ` <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> ,` <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT�ifP USINESSIAGENCY <br /> ADDRESS a.Ba� <br /> PHONq Q� /we I—�1 FACS16111.E �`tF� <br /> TENTATIVE'APPOINTMENT DATE <br /> (Please give 7 to 10 business days Gwn data of application snbmlttap <br /> U- t /75 .-,q, .3 , V- <br /> In CHECK BOX TO EXPEDITE REQUEST-$117.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF.-APPLICANT �� `LL r E 19Ak f- <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Oat Wes .Le. S4-r SftkFc., c <br /> S nm e { _!�+ock4a C <br /> !' ENVIRONMENTAL HEALTH DIVISION FILES <br /> /LI NDERGROUND TANK(UST)CLEANUP SITE(LOP) 13LI <br /> HOUSING ABATEMENT SOD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SDUG WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIE DPERMITTED FACILITY 13IG <br /> MOTELIHOTEL O PUMPER TRUCYAROfCKEM TOILETS <br /> ❑ TTOOIBOOYPEIRCING ❑ POOLISPA "- ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTFU FACILITY ❑ PUBLIC WATER SYSTEM O 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 chocking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mall to the <br /> address indicated above. <br /> 2. END will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but no laterthan ten(10)days after receipt of application. The files <br /> will he held far a maximum of five businecc days for review. Appointments should he Sr.Y1Prli lAd <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 /> 7. *TENTATIVE 0vpv(,rLrrni,t.l.iEba ri>,ust ba confirmed with END 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 /> eM mid a mo <br />