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SAN . 1QUIN COUNTYPUt3LIC HEALTH S VICES <br /> IC- —ENVIRONMENTAL HEALTH DIVISIO:a' <br /> 304 E45T WEBER AVENUE,THIRD FLOOR <br /> /I STOCKTON CA 85202 �J C �J / <br /> 7S J U L 2 3 Z001 (209)468-3420 \,5)— / <br /> (f PUBLIC RECORDS RELEASE APPLICATION <br /> APPL`CANTj' � 7 'r'9� ' �-'� SUSINESSIAGENCY <br /> ADDRESS 8JOezd <br /> PHONE �D9 4/larl-10�b _.FACSQi11LP a7Q7- 707 1 ' - <br /> TENTATIVE'APPOINTMENT DATE_ Sp0 V1. -- TIME '- <br /> (Please gwe 7 to 10 business days I, Aata of apPlicaUaa subMlttan <br /> Z//(/7 �, <br /> CHECK BOX"i0 EXPEDITE REQUEST-$ 0 FL QUEST PROCES$EA IN 3 BUSINESS DAYS <br /> SIGNATUREOFAPPLICAN- l DATE 23 OI <br /> FILE ADtlRESS <br /> LA <br /> F � O <br /> o. <br /> \ti - <br /> V �Olr N �t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK[UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WA57E VEHICLE <br /> UNDERGROUND TANK(MONIYORINGIREMOVALI ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKJYARDJCHEM TOILETS <br /> ❑ TATTOOIRODY.PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SrrES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> d <br /> 1, list op to ten addresses in the space above. Select the type(s) of flies 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 it any EHD files exist. An appointment for review will he 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 /> rH 00 a MIMs <br /> .d <br />