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a .:ryG� lit. r.etc <br /> a£rnD cU r _.._. AN JOA�i.N COUNTYPUBLIC HEALTH SER&S r14nL= <br /> W�'��u `/ ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> AUG 9 2000 STOCKTON CA 95202 <br /> (209) 4683420 <br /> E_NVIRO LTHPVgLIC RECORDS RELEASE APPLICATION <br /> 0.ns�r BUSINESS/AGENCY <br /> R - <br /> _ <br /> PHONE t�FacSlmae - OIC 2 1 <br /> TENTATIVE'APPOINTMENT DATE 1' n ( 1 TWE `O <br /> r�r� (Ptease gira 7 to iD bvFinoss frog+date of applioa0m a`ubmittdl) <br /> L-� CHECK BOX TO EXPEDITE REQUEST.-E .00 FEE—REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT �-f DATE ba0 <br /> FILE ADDRESS <br /> a' <br /> I D0O � <br /> t <br /> Ulu <br /> I my <br /> ENVIRONMENTAL HEALTH DIVISION PILES <br /> 21�UNDSRGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SUUU WASTE FACILITY <br /> OTHER CLEANUP SITE(NON10P) 0 FOOD FACILITY 0 SOLID WASTE VCHICL£ <br /> UNDERGROUND TANK(MONNTORINWREMOVAL) O DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 fAOTEL)NOTEL 0 PUMPER TRUCWYARDHCHEMTO ETS <br /> O TATTOOIBODY P6IRCING ❑ POOLISPA ❑ LAND USE APPLIWION SITES <br /> 0 MEOICAL 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 /> addre4r, indleated abovo. <br /> 2. EHD will notify the applicant if any EHD tiles 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 husiness 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 /> a. Applications received after 3:DO pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INrrIAL5 <br /> REVIEWED YES NO REVIEW DATE <br /> En vv �• vupgpE <br /> TOTAL P.02 <br />