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uAiE NECFvEL <br />SAN JOAPIN COUNTYPUBLIC HEALTH SE 'ES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468$420 <br />PUBLIC RECORDS RELEASE APPLICATIOM <br />APPLICANT <br />ADDRESS <br />PHONE <br />6ilU {w.Vi AVM1i£.. <br />TENTATIVE` APPOWTMENT DATE TWE <br />(Please give 7 fo ie bu inbss days from date or application submil[al) <br />C] CHECK SOX TO <br />SIGNATURE OF <br />FEE - REOUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE <br />1/ i <br />i_ List up to ten addresses in the space above. Select the type(s) of F rom the lista checking <br />the appropriate box(es). At least one file type MUST be selected Fax to (209)464-0138 or m it to the <br />addre s Indicated above. <br />2. EHD will notify the applicant if any EHD flies 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 fife reviews by the same applicant may require a $78.00 deposit prior to review- <br />s. ^T TATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />YES NO <br />TIME <br />PHONE FAX INITIALS <br />TOTPL P.02 <br />ENVIRONMENTAL HEALTH DIVISION FILES OCT 2 9 2201 <br />UNDERGROUND TANK (UST) C1.EANUp <br />SITE (L0P1 ❑ HOUSING ABATEMENT <br />N"C) JD WASTE FACILITY <br />OTHER CLEANUP 5rCE (NON -LOP) <br />O FOOD FACILITY <br />�7—SOLID WASTE VEHlGIF <br />UNDERGRDUND TANK (MONITORINGIREMOYAL) O DOG KENNEL <br />❑DAIRY <br />HALIRDOUS WAs GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TRE TME.NT PLANT <br />iYEREO PERMITTED FACWTY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKfYARDfCHEMTO{LE3 <br />❑ 7ATt0p1UODY PE{RCING <br />❑ pOOLfSPA <br />O LANG USE APPLICATION SrtEs <br />O MEDICAL WASTE FACILRY <br />❑ PUBLIC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />i_ List up to ten addresses in the space above. Select the type(s) of F rom the lista checking <br />the appropriate box(es). At least one file type MUST be selected Fax to (209)464-0138 or m it to the <br />addre s Indicated above. <br />2. EHD will notify the applicant if any EHD flies 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 fife reviews by the same applicant may require a $78.00 deposit prior to review- <br />s. ^T TATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />YES NO <br />TIME <br />PHONE FAX INITIALS <br />TOTPL P.02 <br />