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Ali S,"NiAlLujiN tlUCriYlLrLJCrJ fl�lii �i .�v; <br /> I_t VIRONMENTAL HEALTH DiVISit R <br /> MAR 1 3 Zhu) 304 EAST WEBER AVENUE,THIRD FLOG <br /> STOCKTON CA 95202 <br /> LI _ALTH (209)'468-3420 <br /> _; 11`` PUBLIC RECORDS RELEASE APPLICATION, � <br /> A l Vl I tof BUSINESWAGENCY dCuaj!In( <br /> 3,7 &t) Road. <br /> clCf� G4 9 /s��ls <br /> - NEFACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give T to 0 twsin days Iran date of appGcaliw submittal) <br /> 46-1 ao <br /> �l CHECK BOX TO EXPEDITE REQUEST FEI RE EBT PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT , e _ DATE <br /> FILE A13DRESS -�•,ro� - - <br /> Ful S S n� v O <br /> YI'M ru <br /> fNc <br /> f rJFZl�' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Nr UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ARATEMENT ❑ SOLID WAS tE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOL)FACILITY ❑ SOLID WASTE vEHICLL <br /> UNDERGROUND TANK(MONrTURINGlREMOVAL) ❑ DOG KENNEL. ❑ DAIRY <br /> HAZARDOUS WA51E GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTECI FAC 1-i Y ❑ HOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> q TATTOOIBODY PEIRCING ❑ POOLJSPA ❑ LAND USE APPLICATION SMZ <br /> O MEDICAL WASTE FACILITY a PUBLJC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY AROVE) <br /> 1. List up to ten addresses in the space above, Select the type(s) of tiles from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091 4 64-111 38 ar mail to the <br /> address indicated above. <br /> 2 EHO will notify the appUcant 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 an by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is dvailable. <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 TIM£ <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 46 1a f7 4 '� <br />