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care RLct:lvFn • <br /> SAN JO^JUIN COUNTYPU13LIC HEALTH Sl--VICES k110LCV NUMBIft <br /> VIRONMENTAL HEALTH DiVISIC <br /> 404 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCK TON CA 85202 <br /> (z09)46$-3420 <br /> A PUBLIC RECORDS RELEASE APPLICATION <br /> APS"JCAN7_tyl a r iti tc5 BU$R�E5SJAGENCY av�c�Or cr t,t �vt p o [QS T►tc. <br /> ADDRESS 1 f3 Bn P'Q'vt k 1Aj¢ <br /> PHONE - 2.1 - a S t B QAC-51MI E 2 0"r <br /> 16\1 <br /> TEiNTAT1VE•APPQWTW-XT DATE __ 77hA1= <br /> (PI'S give 7 to 10 buSktess days from date of application sutultl'.ta!) <br /> L4tj1 rS a, 3, <br /> CHECK I3OX TO EXPEDITE REQUEST--$87_.00 FEE—REQUEST IN BUSINESS DAYS <br /> QUEST <br /> SIGNATURE OF APPLICANT —!� fZQCl; DATE <br /> FILE ADDRESS TI-M SIDE CCHD STAFF 115 ONLY <br /> PROGRAM EL EULWs SEARCH <br /> 10 oqu K I.&-, bi% 3� :YW <br /> w. <br /> SS <br /> ^I O Imo. 00.11 JOQ µ. K k. <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> 15:�tNVERGRGUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATENIENT L4/SOUD WASTE FACIU Y <br /> a- OTHER CLEANUP SITE(NON-LOP) 17 FOOD F= rrY IaR SOUR WASTE VEFHCIE <br /> fii'urmF-RG ROUND TANK(YONITORINGfREMOVAL.) ❑ DOG KENNEL d DAIRY <br /> 13-HAZARDOUS WASTE GENERATOR 11 CHICiC!~N RANCH C PKG TREATMENT PLANT <br /> Q TIERED PERMn-TED FACILITY R MOTI:LHOTEL Q PUMPER TRUCXIYARDJCHEM TMETS <br /> ❑ TATTOOIBODY KIRCiNG 0 PQG115PA Cl L_ANI)USE APPLJCATioN SITES <br /> I3'htEDICAL WASTE FACILITY C1 PUBLIC WATER SYSTFM 0 OTHER(PLEASC SPECIFY ABOVE) <br /> 1. list up to ten addresses in the space above. Select the tyPO(S) Of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected, Fax to(2091 4_0+01:3 or mail to ti1Q <br /> address indigte altaove, <br /> 2. Ef-10 will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately fire business days but no later than ten(f 0) days after receipt of appllcation. 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 condltlon as released will be reorganized by EHL7 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 CON>'IRMF-D ;PHONE FAX INITIALS <br />