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1 05/09/2002 15:11 2094671_, AGE STOCKTON <br /> _• sHo Loo aurne AGE 01/el <br /> y <br /> LLA It neuervnu <br /> SAN JOAQUIN GOUNTYPUBLIG HEALTH SERV! <br /> IRONMENTAL HEALTH DIVISION <br /> n f <br /> EAS7 WEBER AVENUE,THIRD FLOOR <br /> K S70CKTON 95202 <br /> ; <br /> ca �•� (209)aea-3-3 azo TO <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT U <br /> BUSINESS,AGENCY Q / <br /> ADDRESS 3 Q <br /> PHONE as 9) V iDo6 FACSIMILE <br /> 17 <br /> TENTATIVE"APPOINTMENT DATE <br /> Q 13 ME orr�B'� <br /> (Please give T��/gs s om d of appll tion submittal). - <br /> CHECK BOX TO F-XPEDtTE REQUE -$78.00 FEE-REQUESO IN 3 SINESS DAYS ' <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> p ckmn <br /> tl � <br /> gr 7b CY-u n <br /> w t <br /> ENVIRONMENTAL HEALTH DIVISION FILES f ,' <br /> W <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP 917E(NON-LOP) ❑ FOOD FACILITY ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ MOTEtJHOTEL ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING [I P ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY ❑ PUUBLICBLIC W WATER SYSTEM <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 (2)9) 864-0138 or mail—10-219. <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 EMD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $76.00 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 <br /> FAX =INITIALS - <br /> PHONE <br /> REVIEWED YES NO REVIEW DATE <br /> Er, oo 14 .".. <br />