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� DATE RECEIYF9 ' <br /> SAN JOABb"'1N COUNTYPU13UC HEALTH SE rt5 <br /> _ <br /> El IIIRONMENTAL HEALTH DIVISIONWS 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> us (209) 488.3420 <br /> P LIC RECORDS RELEASE APPL.ICA N <br /> APPLICANT- I--1 _ HUSIHESSfAGENCY �• <br /> ADDRESS Q <br /> PHONE 47o 9) V10 r/ LQd b FACSIMILE // <br /> TENTATIVE`APPOINTMENT DATE G� t/C11`o2Z TimE ! 0'c0 <br /> 0 A°.'4 ° <br /> (Please vivo 7 to 10 hum=s ys from data of application submlUap ._. <br /> LL�iTS _�C 1 16 41 — <br /> CHECK BOX TO p(PEU17E REQUE 78.00 FEE-REouE^T ROCESSED IN 3 BUSINESS DAYS /I n <br /> IGNATURF OF APPLICANT DATE U V <br /> FILE ADDRESS <br /> FL I, aftaft <br /> _L <br /> fit Al 11A� <br /> d r rA <br /> DS <br /> 3 � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK tUST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LLP) O FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HA4ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY Cl MO7ELH0TFL C PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIaODY FORCING ❑ POOIJSPA C LAND USE APPLICATION SITES <br /> C 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 least one file type MUST be selected. FaXto (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant it 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 hold 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 /> CONFIRMS® APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />