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qu6 S I UU,I Eno LOG NUMBER <br /> V}�n y�V udG i6:Uu 2U5�ibr1 <br /> SAN JO UIN COUNTYPUBLIC HEALTH SE�.vICES <br /> S 1 y ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468.3420 <br /> / PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENCY +�" /• <br /> APPLICANT <br /> ADDRESS Q / <br /> PHONE F CSIMILE <br /> TIME IL/•✓'� <br /> TENTATIVE"APPOINTMENT DATE e of appIlcatlon s <br /> (Please give I t 1 business days fromtuhmlHaq <br /> �1 ti/T5 3, <br /> CHECK BOX TO EXPEDITE RE QU 578.00 FEE-RE UST PR <br /> SED IN 3 BUSINESS DAYS <br /> /� DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> r i <br /> U)? t7 b <br /> w <br /> 3 <br /> It ++ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Q CHICKEN RANCH DOU KENNEL ❑ PKG TREATMENT PLANT <br /> HA7AR000S WASTE GENERATOR ❑ CHICKENMOTELIHRANTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> TIERED PERMITTED FACILITY 0 poOVSPA [3 LAND USE APPLICATION SITES <br /> ❑ TATTOOIBOOY PEIRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses In the space above. Select the types) of files from the list above by checking <br /> ype MUST be selected. Fax to (209)464-0138 or mall to the <br /> the appropriate box(es). At least one file t <br /> address indicated a ove. <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 <br /> receipt <br /> thou dof application. <br /> The <br /> files <br /> Will be held for a maximum Of five business days for review. App <br /> uled <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. reorganized b EHD staff at the expense <br /> 4. Any file not returded in the same condition as released will be reorg Y <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 <br /> TIME <br /> PHONE FAX INITIALS <br /> DATE CONFIRMED <br /> REVIEWED YES NO REVIEW DATE <br /> EII 0014 0L0NOa <br />