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J LI III 1.11, 11111+I.I_I. <br />SAN JC JUIN COUNTYPUBLIC HEALTH! .VICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />Q� <br />STOCKTON CA 95202 Ll <br />AUG 9 ZQ (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT As BUSINESS/AGENCY«'a7ce (1%cL> <br />ADDRESS 9-0)C�)y 1'V1?_c /3 e- Z /1�110 rt C c� 3 S <br />PHONE?_Jr "�3 3 FACSIMILE Sr —6 3 21 <br />TENTA41VE" APPOINTMENT DATE= TIME <br />(Please give 7 to 10 business days from date of application submittal) <br />❑�N� <br />CHECK BOX TO EXPEDITE REQUEST - $07.00 FEE -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �= %.Z DATE <br />FILE ADDRESS [_ THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />C' ep rvt <br />s a S .. f3 57<r,-, -f — I o'1' -V' _ ,l–r,– I I I I I <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />i, <br />❑ UNDERGROUND' TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT <br />❑ <br />SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ <br />FOOD FACILITY <br />❑ <br />SOLID WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ <br />DOG KENNEL <br />❑ <br />DAIRY <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />❑ <br />PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ <br />MOTEL/HOTEL <br />❑ <br />PUMPER TRUCKIYARD/CHEM TOILETS <br />❑ TATTOO/BODY PEIRCING <br />❑ <br />POOUSPA <br />❑ <br />LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />PUBLIC WATER SYSTEM <br />❑ <br />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 17eld 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. Applicatitns 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 00/07/00 <br />