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DATE RECEIVED �, EM "9119 . <br /> SAN JCUIN COUNTYPUBLIC HEALTH 'RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 i,'f ,h l_?f <br /> (209) 488-3420 !. <br /> PUBLIC RECORDS RELEASE APPLICATIIAPP -g p1r r <br /> a <br /> APPLICANT^Q^ Q�f' _BUSINESSIAGENCY In �S <br /> ADDRESS <br /> PHONE ' FACSIMILE„ <br /> TENTATIVE'APPOINTMENT DATE 4 TIME. "75 D.m <br /> (P ea e give 7 to 7�tn�`ys ft rrs date of a piicatlo�n submittal) - <br /> CHECK SOX TO EXPEDITE REQUEST-$87.00 FEE—RE4UEST P SED ABUSS DAYS l <br /> SIGNATURE OF APPLICANT QLzr - DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> o YG asr <br /> Y .• <br /> �. <br /> 0 _ � I <br /> D <br /> ve Y Nva -1 M at-w-v r -F <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ��,i; <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT n SOLID WASTE FACILITY <br /> C OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M�JNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> �DOUS WASTE GENERATOR 0-'CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL HOTEL ❑ BUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING 4 ❑ pOOLISPA V LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List <br /> u to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> p o the <br /> the appropriate box(es). At least one file tyre MUST be selected. Fax to 209 464-0138 or mall t <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 $87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Ir S. 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 - RFVIFW-DATt` <br /> r <br />