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SA*AQUIN COUNTYPUBLIC HEALT ANP�RVICES k <br /> ��I� f( Uj ENVIRONMENTAL HEALTH DIVISI N <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> nS Jt1L 2 3 2001 (209)468-U20 <br /> I } , PUBLIC RECORDS RELEASE APPLICATION <br /> APPL(IANT)Ii l7l�� y..G BUSINESSIAGENCY LlOudytl � .UIPd!!it'IP�ttl1( rC <br /> ADDRESS <br /> �}�217�Slt/a OW R , � fldetylL <br /> PHONE-, l -J& ! -IQ610 <br /> TENTATIVE`APPOINTMENT PATE_ _ AVOW _ TIME <br /> (Please give T to 10 business days ho data of apptleatlan submittan <br /> CHECK BOX TO EXPEDITE REQUEST-$ - 0 F - QUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLJCANT _ I IZ DATE Z3 0 1 <br /> FILE ADDRESS <br /> sz7 <br /> s - <br /> z <br /> z� <br /> 3S K <br /> a <br /> .d <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ,UNDERGROUND TANK(UST)CLEANUP SITE(LDP) ❑ HOUSING ABATEMENT In SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON4-OP) ❑ FOOD FACILITY ❑ SOLD WASTE VEHICLE <br /> UNDERGROUND TANK tMOWTORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZAROOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY R MOTELINOTEL ❑ PUMPER TRUCIVYARDICHEM TOILETS <br /> EI TATTOoiBOOY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SrtES <br /> ❑ MEDICAL WASTE FACILIFY ❑ PUBLIC WATER SYSTEM M 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 12091464-0138 or mail to the <br /> addressindlcated above <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately rive 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 sttould 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 Tile 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 /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will he processed the next business day. <br /> CONFIRME6 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> M W 14 e1IDyW <br />