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pAIE AEGEiV6a flG.fib NW4.GEl: <br /> .i.' SAN JOA GOUNTYPUBLIG HEALTH SERV <br /> ENv, ONMENTAL HEALTH DIVISION <br /> AUG 1 3 2001 C3 `�' 304 EAST WEBER AVENUE,THIRD FLOOR �� <br /> L STOCKTON CA 95202 <br /> (208)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ? '.'^�s1�/� LGzDUSINESSIAGENCY <br /> ADDRESS <br /> ���- Cj CUMPHONB�d OQb ��'Y S FACSIMILE V�� <br /> TENTATIVE'APPOINTMENT DATE /f 'gar <br /> (Please give 7 to to business day3 Tran data of applicatlon submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST--$LI7.00�FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS r <br /> SIGNATURE OF APPLICANT ATE <br /> �p <br /> FILO ADORESS THIS SIDE EHO STAFF USE ONLY <br /> JPROGRAM ELEMENTS SEARCH <br /> O� Wes c le. SLr SfafcKn c <br /> S A644 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> /� DERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATENIIENT SOLID WASTE FACILITY <br /> MERCLEANUPSITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORWGIREMOVAL) ❑ DOG KENNEL El DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIE DPERMITTED FACILITY 13 MOTEUHOTEL O PUMPER TRUCKMAROTCHEM TOILETS <br /> iTOOfBODY PEIRCING LIPOOLISPA - ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM O 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 tQ the <br /> addressindicated above. <br /> 2. EHD will notify the applicant if any END files exist An appointment for review will be confirmed <br /> approximately five business days but no laterthan ten(10)days after receipt of application. The files <br /> will he held for a maximum of five businecc days:for rovew. Appointments should he SrtlPdlllnrl <br /> accordingly. <br /> 3. A file 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 /> 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$87.00 deposit prior to review. <br /> S. `TElfrATIVL appvi,,L,,mA-hits must be confirmed with E•HD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> .d <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INfT1ALS <br /> REVIEWED YES NO REVIEW DATE <br /> lMNN a M <br />