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SAN J UiN COUNTYPUBLIC HEALTH S VICES <br /> S14 - VIRONMENTAL HEALTH DIVI I <br /> RU <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468~3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A PLIcaNT 1Gi" 1 ' t ..J_, ,1 auslN�ss�AG�1�Ctr UGt1�CP0► 1�Y�7 �� '�,2 . <br /> ADDRESS '7 Q � !!J UJ}!(�d� l� Cb00 5�3 <br /> PHONE <br /> r t7 d f1 f V 11� <br /> FACSIMILE �f <br /> C <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to'o b sines days from dale of appliuet;on submittal) rn Do <br /> --� <br /> GIiEGK BOX T4 EXPEDITE REQU T-$T8.44 FEE—REQUE T Rt3 ESSED IN 3 BUSINESS DAYS T p <br /> SIGNATURE OF APPLICANT DATE MAI <br /> S <br /> FILE ADDRESS C <br /> e 5<zl17 717 tE AwJ <br /> t� cZi <br /> ►� S 12 " <br /> £ e X303 <br /> a-3U1 <br /> D _ <br /> Road C? <br /> St- <br /> LAI <br /> o , no lei`es its IV% 0 V'r- 8 - ., # ftt Sly f <br /> ENVIRONMENTAL HEALTH (DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> L7 TIERED PERMITTED FACILITY b MOTEIJHOTEL ❑ PUMPER TRUGKlYARINCHEM TOILETS <br /> 13 TATTOOIBODY PEIRCING Q PQOLfSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER.SY$TEM 'PCOTH�LP�L�E SPECIFY AEIO a <br /> 1. <br /> List up to ton add rssses In the space above. Select the type(s)of files from the list bove�iy c�hJecking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 20J 4 r4-0138 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 (40) days after receipt of application. The files <br /> wilt 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 /> S. 'TENTATIVE appointment dates must be corifirmed 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 /> Eli 09 14 01!O= <br />