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Gl/U//2&J2 lb U/ 2094d71i1d HUE S)UL,KIUr, <br /> ATER6CBVED SAN JOA�IN COUNTYPU13LIC HEALTH SEES EHotoGaumaO�- <br /> ENVIRONMENTAL HEALTH DIVISION rC <br /> 1 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 1 STOCKTON CA 95202 /' <br /> �1 (209) 468-3420 / <br /> PUBIC RECORDS RELEASE APPLICATION <br /> APPLICANT ESSIAGENCY a �• <br /> ADDRESS 6 �f <br /> PHONE a09) y107 i0o6 /FACSIIM,MILLE / /0 16Y,Q • <br /> TENTATIVE'APPOINTMENT DAYE //J SJGA010 TIME /U 16Y � r <br /> (Please give 7 to 10 business days from date of application submittal) <br /> �yp1 Gl UI775 2, Ll- <br /> CHECK BOX TO EXPEDITE REQU ST-$78.00 FEE—REQUE T ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> fr p <br /> )l(/ d Ir <br /> V EMU <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HATARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKO TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOL/SPA - Cl 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 $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 /> En oo a o�rosaa <br />