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LHU LUb NUMBLk <br /> UHILh L­�U <br /> SAN JOAQUIN COUNTY <br /> EOIRONMENTAL HEALTH DEPAR .ENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 56)STOCKTON CA 95202 I <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> A, <br /> APPLICANT BUSINESSIAGENCY <br /> S2 `�S81Z <br /> ADDRESS r7 • ". ': <br /> PHONE '[I&- T I a S� FACSIMILE 9 1 6 /T-T C• TO 4' A.;:��t "'1 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of application submittal) .� �� <br /> HECK BOX TO EXPEDITE REQUEST-$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS �, <br /> SIGNATURE OF APPLICANT � DATE 4 [44o'3 <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> Q O1 rt- ' 1NC.LQ/YL UIE <br /> ¢v0 <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> fD NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> pTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> `UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> C3 }}AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ MPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOPERMIIBODY TED FACTCING ❑ OLISPA LAND USE APPLICATIOtLSITES <br /> ❑ MEDICAL WASTE FACILITY m OTHER(PLEASE SPECIFY)�"G�TI C_ <br /> C 1/C T'1=�A S <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 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 $89.00 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 days <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD I8-0240 <br /> MW2000 <br />