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UA 1 L RECEIVEJ� n U EHU LOU NUMt3ER <br />�l//�Uj�1jj111 SAN JOISUIN COUNTYPUBLIC HEALTH VICES <br />-101 VIRONMENTAL HEALTH DIVISIO <br />9, <br />V �() 304 EAST WEBER AVENUE, THIRD FLOOR l ;� <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />RUSIR <br />APPLICANT-��1(,( , I t (�( BUSINESS/AGENCY tr(a2�1 1' <br />ADDRESS 123 0C�rn rrLA,4rC'SL t :i V_ � �OX VAylAedr, l � X 9t 86 <br />PHONE 14 31 `t - 2200 '' FACSIMILE 10 E0L - -2ZZ.2 <br />TENTATIVE* APPOINTMENT DATE I - -OL <br />(Pleasegive 7 to 10 business days fro <br />CHECK BOX TO EXPEDITE RE <br />ICG. OF APPLICANT <br />'7112 TIME q. A." <br />m date of application submittal) <br />- $78.00 FEE „REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE 7--L — UC3 <br />.303 t,. " E LIC ��' <br />FILE ADDRESS <br />THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />jZ t` <br />u A L &t> 1 <br />0'1 <br />ao <br />7-3c) <br />EL -M Lv ®1 <br />380 a Cc, 1 ,23 <br />O Q 309 <br />31'2 <br />E I - r-1 Lott"% <br />eS <br />S i <br />10-`t <br />LM <br />SCA- L L-0 A 1 <br />� <br />SZ %TS -031 <br />-L q <br />L i&i At 1"JE -t'kA `Yto <br />CHICKEN RANCH 13PKG TREATMENT PLANT <br />❑ <br />TIERED PERMITTED FACILITY <br />W. <br />(aRA<tATL-1+J e -T Y G <br />❑ <br />3S� <br />52�-e <br />I- W. <br />E f2A Com( <br />Q ` T �i <br />a <br />0 <br />2-142 i <br />0-0 L_�°1 -Tf2 A• C Y <br />.303 t,. " E LIC ��' <br />4- K 0o A MYesS <br />L L ENVIRONMENTAL <br />HEALTH DIVISION FILES <br />UNDERGROUND TANK (U ) CLEANUP SITE (LOP) <br />13 <br />HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />13 <br />FOOD FACILITY 13 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ <br />DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH 13PKG TREATMENT PLANT <br />❑ <br />TIERED PERMITTED FACILITY <br />C3MOTELIHOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ <br />TATTOO/BODY PEIRCING <br />❑ <br />POOL/SPA C3 LAND USE APPLICATION SITES <br />❑ <br />MEDICAL WASTE FACILITY <br />❑ <br />PUBLIC WATER SYSTEM 13 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 />CONFIRMED APPOINTMENT DATE ` TIME --- <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YE:; NO REVIEW DATE <br />EH 00 14 02124/00 — _ — -- <br />