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DA7E KEGEIVkDf <br /> SAN JO.4QUIN COUNTYPUBLIC HEALTH Sr-e,RVICES <br /> IVIRONMENTAL HEALTH DIVISf" <br /> 04 EAST WEBER AVENUE,THIRD FLOOR <br /> APR 0 :1 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ),j SUSINESSIAGENCY <br /> ADDRESS <br /> PHONE FACSIMILE FC '1 �� L <br /> TENTATIVE* TIME Ll 1j, <br /> (Please give 7 to 10 business days from date of application submittal) <br /> -REQUEST P O ESSED IN 3 BUSINESS DAYS �� ' <br /> CHECK BOX TO EXPEDITE REQUEST $89� E—'REQ 40 <br /> t, <br /> TO U-11. <br /> SIGNATURE OF APPLICANT DATE <br /> THIS SIDE EHD STAFF USE ONLY. <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> lc(LCI �I . �11T1�L�L�L ` tiS.fv✓�Lv1 C_� I�ZZCa <br /> cl rte I ►-! (l L + L se4c c`C, v4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> f� UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY " <br /> 13 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY •❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOd KENNEL 0 DAIRY <br /> 125,HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ElTATTOOIBODY PEIRCING C7 POOUSPA A LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ ❑ 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 EMD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (1,0) 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 $89.00 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 /> EHO 48-01-046 <br />