Laserfiche WebLink
SAN \OUIN COUNTYPUBLIC HEALTH RVICES <br /> I *NVIRONMENTAL HEALTH DIV15g1 <br /> IL'I r l�D 304 EAST WEBER AVENUE,THIRD FLOOR_ I I <br /> MAR 2 2 Z��I STOCKTON CA 95202 <br /> (209) 468-3420 <br /> Ei 1F ,i I Him PUBLIC RECORDS RELEASE APPLICATION <br /> PER MITr`1�P" �Ir)Ud�fLPO (}�lJ�f1r l <br /> APPLI BUSINESS/AGENCY <br /> /�/S!Q /�7 �Of��oad oc,�te n., (s//��Js <br /> ONE D(�7 -7 - FACSIMILE / b / ljle? <br /> in I <br /> TENTATIVE*APPOINTMENT DATE 3-� TIME U <br /> (Please give 7 to 10 business days from date of application submittal) <br /> 21 CHECK BOX TO EXPEDITE REQUEST-$7811 FEE- ES EQUROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> txv <br /> hlot <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> —''%UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> F HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL C3PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ClPOOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 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 $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 /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01/05100 <br />