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Ui�i t KEC rIV'E,1� n u EHD LOU NUIVItiEK iCEIVSAN JO UIN COUNTYPUBLIC HEALTH VICES�&_ jVIRONMENTAL HEALTH DIVISIOlJ" 304 EAST WEBER AVENUE, THIRD FLOOR I 1 2 STOCKTON CA 95202 nt- l Ij (209) 468-3420 `� PUBLIC RECORDS RELEASE APPLICATION RUAlwhim APPLICANT 1, 4j,1 1 /y BUSINESS/AGENCY �•►r(�aul� [, ADDRESS ��y12Z t '(�YYt rYi Jit -ru_ t ,t 4� C.� it lM P y e 1 ^ - PHONEg14 f5b 4 - 2200 — FACSIMILE CItU ). 15-&4'- Z.ZZ2. TENTATIVE* APPOINTMENT DATE (Pleasegive 7 to 10 business days fro CHECK BOX TO EXPEDITE RE ICG. OF APPLICANT TIME q: 00 A -M m date of application submittal) - $78.00 FEE -,REQUEST PROCESSED IN 3 BUSINESS DAYS DATE 7—b—(00 .2cD3 LALA-1, I_ L M LOQ' 1 4- (� 0 1��YesS ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK (U ) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT I] SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL 1:1 DAIRY HAZARDOUS WASTE GENERATOR El CHICKEN RANCH ElPKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEIRCING ElPOOL/SPA 13 LAND USE APPLICATION SITES C3 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day CONFIRMED APPOINTMENT DATE TIME --- DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES, NO REVIEW DATE EH 00 14 02/24/00 FILE ADDRESS THIS SIDE EHD STAFF USE ONLY PROGRAM ELEMENTS SEARCH Za E7L.m LOW i �; a c -P1 .23 O 2 ?,6 3os3 is -`l Gini_ L-0 Al � i SZ c_Y Yes l to �1. (-n RA �Tu IJ E -c c a 3 35a 52 a t- w. N)RA� RA °-r E t� D s a o 2-42it-bL�� -1-RA CY J ° .2cD3 LALA-1, I_ L M LOQ' 1 4- (� 0 1��YesS ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK (U ) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT I] SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL 1:1 DAIRY HAZARDOUS WASTE GENERATOR El CHICKEN RANCH ElPKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEIRCING ElPOOL/SPA 13 LAND USE APPLICATION SITES C3 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day CONFIRMED APPOINTMENT DATE TIME --- DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES, NO REVIEW DATE EH 00 14 02/24/00