Laserfiche WebLink
EHD LOG NOMf3FR <br /> SAN JO. IIN COUNTYPUBLIC HEALTH SFAt,110ES <br /> E IRONMENTAL HEALTH DIVISO <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY„ <br /> ADDRESS (7_TS Z CSA <br /> PHONE <br /> a�� 22 (C2 FACSIMILE 41Ll ZZ2 l(l� <br /> �_ j <br /> TENTATIVE*APPOINTMENT DATE :g6 &0 TIME � <br /> (Please give 7 to 10 busine sdays from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7 �� <br /> C c . <br /> h <br /> FILE ADDRESS <br /> 0 - r, G <br /> iI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> V UNDERGROUND TANK(UST)CLEANUP SITE-(LOP) 0 HOUSING ABATEMENT Cl SOLID WASTE FACILITY <br /> 0 j2rfHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL Q DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> i ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM a OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses inthe 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 YES NO REVIEW DATE <br /> EH 00 14 01105/00 <br />