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ul/M1�7/2UO2 i6:Uu YU546ii Rut b(U�.r.1Ln " '- `" "' <br /> EHDLos NUMBER <br /> SAN JO UIN COUNTYPUBLIC HEALTH SE1�JICES <br /> / ENVIRONMENTAL HEALTH DIVISION <br /> .� 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON 95202 <br /> 17 (2D9) 468-3-3 420 <br /> / PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINE:15, X! NCY eF I <br /> ADDRESS Q <br /> PHONE ao9) V/ 2 i0a6 F CSIMILE <br /> TENTATIVE*APPOINTMENT DATE / I l l Ion TIME Ili I/ <br /> (Plsasa give 7 to 1 business days from date of application submittal) <br /> !a/7-:S 3, V- <br /> CHECK BOX TO EXPEDITE REOU $78.00 FEE—RE UV S,T PR CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT NIX�LI DATE <br /> FILE ADDRESS <br /> mloTT-:�f 70 Nn S.s4 <br /> w" a <br /> fr <br /> If <br /> u /t ;::L& 9 SIJ <br /> 3 if it w <br /> If tt <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAzARo0US WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 13 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) 404-0138 or mall t4 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 $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 _ <br /> TIME <br /> PHONE FAX INITIALS <br /> REVIEW DATE <br /> EN <br /> 00 a 01,M0a <br />