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77 <br /> E}fD 6OG NUMUCR <br /> SAN Jar JUIN COUNTYPUBLIC HEALTH ,o?VICES N <br /> VIRONMENTAL HEALTH DIVIS*.,A <br /> 1111111K N 319 EAST WEBER AVENUE,THIRD FLOOR <br /> RUSrv . STOCKTON CA 95202 <br /> (209)468-3420 i <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT J R Rn/r Y I lr jj I` t 1 N1 �(O _ BUSINESSIAGENCY <br /> ADDRESS �� L ! t;` 1��• (r/}i rk1L t I' Cit SIJ �7U <br /> PHONE -` FACSIMILE NOW 11111mv ' <br /> Gid - 3ckc <br /> TENTATIVE*.APPOINTMENT DATETIME <br /> (Please give 7 to 10 business days from date of application submittal) n <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELE'AEN-"�SEARCH ' <br /> W.1 Er- v--&;1Zfz1�. ,35 8' �IfL 1. <br /> ' w <br /> 4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M/ylt,,'IN (UST)TANK( T)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 1?,�OTHER CLEANUP SITE(NON-LOP) p DOG KENNEL ❑ DAIRY <br /> E,�P/UNDERGROUND TANK(MONITORINGIREMOVAL) C3 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ill HAZARDOUS WASTE GENERATOR 13 NIOTELINOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> Q TATTOOISODY PEIRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> f f1. 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 209 464-013a-or mall 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. review. A new <br /> staff May not be immediately available for <br /> at is actively being worked on by EHD sta y <br /> 3. A file th Y <br /> application may be submitted when the file is available. <br /> r 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 /> Ilf 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 /> FATECONFIRMED <br /> D APPOINTMENT DATE. TIME <br /> PHONE FAX INITIALS <br /> YES NO REVIEW DATE r <br />