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DATE RECEIVED Eourl <br />%SAN JJRUIN COUNTYPUBLIC HEALTH VICES <br />Adft WIN ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 �'� j ~ c, ;;AI I <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATI Pik -g pa 12, 1 n <br />APPLICANT BUSINESS/AGENCY no Ing, <br />ADDRESS 6V ° <br />PHONE oL�J « FACSIMILE <br />TENTATIVE* APPOINTMENT DATE Q-3 tel' TIME - <br />(P ea a give 7 to 10 b ine ; ays m date of a plication submittal) <br />MM® 'Ahlw 00=5 dote <br />CHECK BOX TO EXPEDITE REQUEST - $87.00 FEE -REQUEST P AU SED SS DAYS <br />SIGNATURE OF APPLICANT <br />:E ' <br />THIS SIDE EHD STAFF USE ONLI <br />PROGRAM ELEMENTS SEARCH <br />A Mwvrn a -Y dl-`� "P ) <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />DERGROUND TANK (UST) CLEANUP SITE (LOP) 11 HOUSING ABATEMENT OLID WASTE FACILITY <br />[t7 OTHER CLEANUP SITE (NON -LOP) 13FOOD FACILITY 13SOLID <br />WASTE VEHICLE <br />C9' JNDERGROUND TANK (MONITORING/REMOVAL) E3 DOG KENNEL ❑ DAIRY <br />O'_HAZARDOUS WASTE GENERATOR KCHICKEN RANCH ❑ PKG TREATMENT PLANT <br />IR"TIERED PERMITTED FACILITY Q MOTEL HOTEL ❑LIMPER TRUCK/YARD/CHEM TOILETS <br />E3TATTOO/BODY PEIRCING ® POOUSPA LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY 0 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 $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 />