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UAit hLGLl4 tU _ LI iU L1114U.11ULli� <br />-,'U� SAN JOA N COUNTYPUBLIC HEALTH S ICES Z <br />ENVIRONMENTAL HEALTH DIVISION <br />.JAN O 4 ZUul 304 EAST WEBER AVENUE, THIRD FLOOR <br />�iVliQ�ii;" �1T I'�f 1 STOCKTON CA 95202 ✓ / <br />FcRMF (209) 468-3420 <br />^.� IC RECORDS RELEASE APPLICATION <br />APPLICAN BUSINESS/AGENCY <br />ADDRESS <br />PHONE ql-(� ' LL02/" / FACSIMILE G� /j (� <br />TENTATIVE* APPOINTMENT DATE t/"I 1 0 <br />10 t I TIME ` ' " <br />(Please give 7 to 10 business days fr m date of application submittal) <br />9(CHECK BOX TO EXPEDITE REQUEST - $87.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />tCta4rlo8 ISI&nd - o I W. S4L���' Z 3 - <br />d - Sloow S 9 okAA0 <br />23 • o o• 0 _ IZ W. oSSd,'l <br />ZJ9. OLID- 0 -1300 Lo. 0 al NO M0 <br />3R • o 0-01 — to l� I o SS <br />5a n,�- <br />lq ,c Le, <br />JAN 4 2001 <br />ENVIRONMENTAL HEALTH DIVISION FILESJjL <br />)1 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br />*OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY YsOLID WASTE VEHICLE <br />V�f NDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 $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 DATE <br />DATE CONFIRMED <br />REVIEWED <br />YES NO <br />PHONE <br />TIME <br />FAX INITIALS <br />REVIEW DATE <br />cC <br />