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SAN ,OQUIN COUNTYPUBLIC HEALTFORVICES <br /> ENVIRONMENTAL HEALTH DIVISION U /304 EAST WEBER AVENUE, THIRD FLOOR r7/ q <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> . PUBLIC RECORDS RELEASE nAPPLICATION I <br /> .r APPLICANT t' fny� JVI i1t IJh i.n () BUSINESS/AGENCY 7VXU('it�L2rN (X/�/lln i/Yr✓yr�21�1'�k J <br /> ADDRESS �3-] vl�u) R!X 54CX16� h <br /> PHONE LI67-/006 FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> Ll cJ/TS 3, <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUES ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT jL � DATE 1W <br /> �L <br /> FILE ADDRESS / THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 407 W Fon <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 0' UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ 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 ❑ POOLISPA ❑ 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 $89.00 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 I d 2 LO L-- TIME <br /> DATE CONFIRMED L 16 2— PHONE FAX INITIALS <br /> REVIEWEDYES NO REVIEW DATE <br /> —m n i nnr <br />