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P. 01 <br /> Lt IJ L- <br /> ✓ �J `=.'� SAN OH,.,JIN COUNTYPUBLIC HEALTH Sr_i.✓ICES <br /> S?'i4 <br /> DEC 2 1 ENVIRONMENTAL HEALTH DIVISION <br /> 000 <br /> 2 304 EAST WEBER AVENUE, THIRD FLOOR <br /> ENVIRONSTOCKTON CA 95202 <br /> i'v1ENT FIEALTH (209) 468-3420 - J <br /> PERiIIJIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSIINESSIAGENCY <br /> (� <br /> ADDRESS ' +T-ti-G C- <br /> PHONE FACSIMILE <br /> TENTATIVE' APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> F7 CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> I <br /> i <br /> I' <br /> i <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEAN JP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORIN /REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresse 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 abo e. <br /> 2. EHD will notify the app icant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bus ness 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 /> 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 /> EH 00 14 00107/00 <br />