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SAN J04QUIN COUNTYPUBLIC HEALTH SERVICEe 2Lerl <br /> eNVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD F11-00K <br /> STOCKTON GA$5202 <br /> 1 (209)453-3420 w. <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ADD r e--4 <br /> FACSIMILE <br /> T <br /> TENTATIVE'APPOlicrMENT'CLATL <br /> tv*aw Bite 7 w 10busi;1 ;-4*yrf;Qcn data cdaPpli"tion ustganuQ <br /> w <br /> MECK SOX TO EXPIZOITE REQUIEVY-!UT-00 FEE REQ�PT PROCEMED SK 315LVSLNESS DAYS <br /> I t) DATE <br /> SIGNATURB OF APPLICANT <br /> kGA) <br /> FILE I ADDRESS. T.41IS SIDE Oil)STAFF USE.ONLY <br /> PIRMIRAW ELEMENTS ZEARCH <br /> Cf 700 7 <br /> Q) <br /> '7. <br /> 1-1-2 <br /> �LA <br /> 0 <br /> ENVIRON04ENTAL HEALTH ENVISION FILE$ <br /> UNDERGROU140 TANK(UST)C, NUPSITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> THER CLEANUP StTE(00"4PP) 13 FOOL)FArwUJff M SOLID WASTE VEMLE <br /> UNDERGROUR13 TANK tNOKITORINGIREUOVAU 13 COG KENNEL .0 DAIRY <br /> KAZAP.000S WASTE GENERATOR t 0 CHICKEN RANCH n PKQ TREATMENT PLANT <br /> 0 TIERED 1PVMMT;P FAULtyyMOTELIHOTEL M PUMPER TRJJCK1YAR=HEtA TQ"TS <br /> 0 TALTTQ'OfBOUY PE3KCING 10M POOLiSPA - - (3 LAND USE APPLICAT"STrF--S <br /> C MEDICAL WASTE FACaJTY i M PubUr.WATER SYFMM 13 WHER(PLEASE SPEOIFY AROVE) <br /> i <br /> 1 list Lip to tenaddr4sys in the spact above. Select the type(s)of files from the list above by Checking <br /> the appropriate bo�(es). 4t least one file t)"MUST be WleCted. fax to(209)464-0138 or mail to IM <br /> address indleated atbOve. I 4 will <br /> Z. F-11L)will natify the*pplicaht if any EHD blei;wrist. An ApppirltMent for review II be co"Fl"ricd <br /> approximately five lbusines days but no later than tell(10)days atter receipt of application.*The files <br /> will bi-,held for a n*mimurn: of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is attiveV being:.worked an by F-HD staff may not be irnmoCiat9ly available for review. A new <br /> application may b submiqted when the file Is available. <br /> 4. Any file not returned in thl same-Condition as r*lqa2Fvd will be reorganized by EKD$Uff at the ekponse <br /> of the-2pjp11canL FI[nLire file reviews by the--arne applicant may require a$87.00 deposit prior to review. <br /> 51 'TENTATIVE appointment Dates must tm confirmad with EHO staff. <br /> 6.- Application-s reveWed aftui 3:00 pm will be processed the next business day. <br /> CONFIRMED AppowrmEw DACE TiMt <br /> DATE CONFRIVIED I PHONE FAX INITIALS <br /> REVIEWED YES i NO REVIEW DATE <br /> tm <br /> TUTPL P.01 <br />