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SAN J _ UIN COUNTYPUBLI <br /> CHEALTH S ICES <br /> o �� �IL�DD ENVIRONMENTAL HEALTH DIVISION <br /> LE I 304 EAST WEBER AVENUE, THIRD FLOOR <br /> 1 1 �QOQ STOCKTON CA 95202 <br /> DEC _ <br /> (209) 468-3420 <br /> RONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> rl�t 'r ,.�y Sdn! BUSINESS/AGENCY adU01ILed &L)Jl 'D d ix. <br /> APPLCANT // q�uit- H �„1D�P-/' , l <br /> ADDRESS `70 S !L�• tom-' C S Q tD l7'1 So�OS� <br /> PHONE as - OD FACSIMILE (A 17 <br /> TENTATIVE`APPOINTMENT DATE it-27 " dd TIME <br /> (Pleasa gIw 7 to 10 business days from data of application sutunittal) <br /> CHECK BOX TO EXPEDITE REQUEST•5,78.00 FEE-RE UEST PRRPCCEESSSSF D IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I� <br /> FILE ADDRESS <br /> I itm W 7 �9s3 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 'Y7 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT O SOLID WASTE FACILITY <br /> a FOOD FACILITY E3SOLID WASTE VEHICLE <br /> 13 OTHER CLEANUP SITE(NON-LOR) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ UNDERGROUND TANK(MONITORINGfREMOVAL) CH RAN <br /> ❑ CHICKEN ❑ PKG TREATMENT PLANT <br /> ❑ HAZARDOUS WAS-,E GENERATOR ❑ MKICKEN AN In PUMPER TRUCKIYARDICHEId TMETS <br /> ❑ TIERED PERMITTED FACILITY ❑ LAND USE APPLICATION SITES <br /> ❑ YATTOOMODY PEIRCING ❑ POOUSPA ❑ OTHER(PLEASE SPECIFY ABOVE} <br /> In MEDICAL WASTE FACILITY ED PUBLIC WATER SYSTEM <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2 )91464-01x8 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 recelpt 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, the <br /> 4. Any file not returned in the same condltlon as released <br /> will <br /> may reorganized <br /> quire a$b y E 66 posit ztff t onto revieexpense <br /> of the applicant. Future file reviews by the same app ' <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 /> CONFIRME=APPOINTMENT TIME <br /> DATE CONFIPHONE FAX INITIALS <br /> REVIEWED REVIEW DATE <br /> EH DD 14 11Mv D <br />