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SAN JO 2UW COUNTYPUBLIC HEALTH SE ICES <br /> ARONMENTAL HEALTH DIVISION--� <br /> ya /� 304 EAST WEBER AVENUE,THIRD FLOOR - ,I <br /> I A STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANTBUSINESSIAGENCY DW—Ac d �CQ - <br /> ll/JAk&-�rfl_ <br /> C <br /> ADDRESS p?q 1 � Qogd. S"L6ktxIL , <br /> PHONE 190 `ID <br /> FACSIMILE A2W 57- - <br /> TENTATIVE`APPOINTMENT DATE TIME dR GY 9 S 9 M 1 <br /> (Please give 7 to 10 business days fmm date of appi"tion submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 7 . 0 E- QUEST PROCESSED IN 3 DUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE '7. - 2001 <br /> �I ADD S_L <br /> 23 <br /> 2 gi <br /> 'n <br /> � � N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> EE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILfTY H111 - 1 21,IQI <br /> OTHER CLEANUP SITE(NOWLOP) ❑ FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONVORINGIRETAOVAL) ❑ DOG KENNEL o DAIRY <br /> HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACIUTY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILLYS <br /> ❑ TATtOOJBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPUCATTON SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 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[east one file type MUST be selected, Fax to f2091 464-0738 or moll tD the <br /> aStdressindicated 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$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 /> es as 14 utrowo -- �. <br />