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l DATE RECUVED `_ <br /> SAN JutkQUIN COUNTYPUBLIC HEALTH'RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> O&V 304 EAST WEBER AVENUE,THIRD FLOOR NOV2 <br /> -STOCKTON CA 95242 z!}Q2 <br /> (209)466-3420 ENVIRONMENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION p <br /> APPLICANT INESSIAGENCY <br /> ADDRESSa / tic Fan C�- <br /> PHONE '--/ FACSIMILES d�o r - <br /> TENTATIVE"APPOINTMENT DATE l I �7 ��^" TIME cel <br /> (Please give 7 to SO business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE -4 .6 F -F 0( P C N µ INES AYS <br /> ti <br /> SIGNATURE OF APPLICANT BATE <br /> i <br /> • i <br /> FILE ADDRESS THIS SIDE EHD STAFF Use ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Y Oma[ �DGf�Lar c <br /> I <br /> i <br /> i <br /> . f <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �UNOERGROUND TANK(LIST)CLEANUP SrTE(LOP) 17 HOUSING ABATEMENT OLID WASTE FACILITY <br /> AI OTHER CLEANUP SITE(NONd.OP) 0 FOOD FACILt1Y SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrroiuNGIREi4IOVAL) 0 DOG KENNEL 17 DAIRY t <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH Q PKG TREATMENT PLANT <br /> O TIERED PFRM17TED FACIUTY O MOTEUHOTEL E3 PUMPER TRUGWYARDICHEMTOILETS <br /> 0 TATTOOIBODY PEIRCING o Pd0LlSPA ' •" d*LAND USE APPLICATION SITES <br /> MEOICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of tiles from the list above by checking <br /> the appropriate box(es). At least one file type MOIST be selected. Fax to(209)46410138 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 4 <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 SATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES 'NO REVIEW DATE <br /> Eti ac N oe+or.sse <br /> 2000 TZ909re e0Z Iva LZ:fiT ZOOZ/TT/TT <br /> C <br />