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SAN t0, IJIN COUNWPUBLIC HEALI H SE` IG&b <br /> L-MRONMENTAL HEALTH DIVISION6e <br /> FEB 2 O ZOO1 304 EAST WEBER AVENUE,THIRD FLOOR -2a <br /> STOCKTON CA 95202 <br /> (209)468.342D <br /> Ef,IVIRU�,!W'Ei�1 HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> OL V I n) 1..�� BUSINESSIAGENCY QUUQI7CPD' ()� 0a U, Q12 Ql' jam' <br /> APPLICANT `1 <br /> APD CA Sa .s` - <br /> nmm <br /> 1"hursd- -A 2-271 nME Tao 11.30lqM <br /> TENTATIVE"APPOINTMEtR DATE S.—nS.. <br /> (Pleese give 7 to t0 babiness days from dam of appliptlon submitta)) <br /> T�q(( ul <br /> tom. CHECK BOX TO EXPEDITE REQUEST-$TC. EE RE ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ^ s' DATE O I 0 <br /> FILE ADDRESS <br /> ✓ Z t2 vt' O <br /> alA1 7L 3 L E . <br /> uWF zp 41 <br /> }/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND <br /> TANK <br /> (USTI <br /> TL <br /> C] HOUSING <br /> CI SOLID IYA : <br /> FA <br /> V( UNDERGROUND TANK(NON-LOP) 0 FOOD FACILITY(MONTORING)REIMOVAL) ) ❑ DOG KENNEL MST 0 DAIRY <br /> SOLID <br /> WASTE VE <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ TATTOOMODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION S9j 2 <br /> 13 MEDICAL WASTE FACILITY 12PUBLIC WATER SYSTEM ❑ OTHER tPLEASE SPECIFY ABOVE l <br /> 1. List.up to ten addresses in the space above. Select the type($) 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 $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 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> rH 0 14 olffl a `--" <br />