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LHU LUL NUNWLIl <br /> �o Ef';'r�,;;` !„ SAN JOAQUIN COUNTY <br /> �I�L v c�D Et`CD4 ONMENTAL HEALTH DEPART NT <br /> EAST WEBER AVENUE, THIRD FLO <br /> ,JUN 2 5 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> N1f1hUMNIEN I HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> :�i"'V11 i I <br /> APPLICANT C � BUSINESS/AGENCY <br /> ADDRESS 3�j, � e� A-A-1A c.rL j <br /> PHONE r `r_3� " I- 7L <br /> FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPE-DITE REQUESTVE S 00 F E- EQUEST PROCESSED IN 3 BUSINESS DAYS I' <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 44A D 0 G <br /> ('0C <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> e—OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ff' DERGROUND TANK(MONITORINGIRE M OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 'HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL CI PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOL/SPA El LAND USJE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Q'OTHER(PLEASE SPECIFY) �}Yta�I�h�_O� <br /> Lc- <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 $89.00 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. -10 w41e"In <br /> CONFIRMED APPOINTMENT DATE _�1�`D� TIME , z2a <br /> DATE CONFIRMED PHONE FAX INITIAL21S t <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 40.02-006 <br /> - - <br /> 312W2003 <br />