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L13/.10/Lbbl 11: L1 2el`J-5l9-�'�L5 i•GLl b10 Ai L: rrUE X11 <br /> 0.3-01-2000 09:45AM FRO^:' TO . 54921225 P.02 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES .. .a2 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR r ` • l <br /> STOCKTON CA 85202 J J <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASEN <br /> AAPPLIICATIO I <br /> APPLICANTOr <br /> 1 I^`�t,yJ CLA M'�10� 1 RUSINESSIAGENCY <br /> ADDRESS_.[l( f I✓au-t, 7I VV1 <br /> PHONE Za9 — FACSIMILE <br /> e <br /> TENI'ATIVE•APPDINTMFNT DATF ��S��l TIME rv0'Q <br /> (PI""give 7 to 10 business days from Cate or appftalion submittal) <br /> � <br /> (' _4 20 <br /> .1^" CHECK BOX TO EXPEDITE REQUES(T�-$78.00 FEE <br /> //-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DiUe� VCv.� /�- DATE 3 3U�01 <br /> FILE ADORES$ <br /> 1 <br /> ( 113 Sew Jved, S c. Z' _ <br /> (dl's Ska.,U P�>.c1 Seoc.11.�n <br /> Z Skate e �D <br /> a lO� <br /> loll R r'o�L "-AL� S bac r FQ — <br /> !Co` A F O <br /> 3 3� �rJcll�.r•loa IQ sod $1oc,k_4�o�____�_ �� <br /> 5 �' Wa +baa od SI,ocY.hon <br /> ENVIRONMENTAL HEALTH DIVISION FILES I t <br /> 1I UNDERGROUND TANK(UST)CLEANUP SITE(COP) ❑ HOUSING ABATEMENT O SOLID WASTE fAC1UTY �\ <br /> O OYHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VENICLE <br /> DQ UNDERGROUND TANK(MONITORWG/REMOVAL) 0 DOG KENNEL ❑ DAIRY 1 <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH C] PKC TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TROCKIYARDICHEM TOILETS <br /> n TATTOOIBODY PEIRCING ❑ POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by Checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209141 4-013@ QLmail to t <br /> A4$ffese Indi eatod hove. <br /> bX <br /> 2. EHD will notify the apPlicant If any EMO files exist. An appointment for review will be Confirmed <br /> approximately five bU$Ineas 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 fele that Is actively being worked on by EHD staff may not be immediately available for review. A now <br /> Application may be submitted when the file is available. <br /> a 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 $18.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dales must be confirmed with EMD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE ^!~ TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br /> LREVIEWEO YES NO REVIEW DATE <br /> TOTAL P.02 <br />