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i, ..vvi v .> > �jlllll <br /> Oa7E RECEIVED <br /> SAN JC ~QUIN COUNTYPUBLIC HEALTH RVICES <br /> '"WIRONMENTAL HEALTH DIVISIt—_,4 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 1 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTlG � BUSINESS/AGENCY <br /> 3t�fo4 IKA�I <br /> ADDRESS Caf1M /- �f <br /> PHONE �f9•S� .7�`f� FACSIMILE 4916, 0 . <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK SOX TO EXPEDITE REQUEST- 7 EQUEST PROCESSED IN 3 BUSINESS DAYS f <br /> SIGNATURE OF APPLICANT DATE rZ Z� 4d <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY . <br /> PROGRAM ELEMENTS SEARCH <br /> Z46q E,42,r <br /> MOW utx Z o <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOLID WASTE FACILITY <br /> ❑ THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> f� UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING 12 POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ 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 (209) 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 /> 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$78.00 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 02/24100 <br /> TOTAL P.02 <br />