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r7rl'C nttik:veu wo L"mrfurR <br /> SAN JUIN COUNTYPU13LIC HEALTH 5�.W1lICES 0: <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE= THERU FLOOR <br /> STOCKTON CA$5202 a����7 2001 <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICAT[04-:NVii?i�nVi✓.rEN;- �;� Ih <br /> APPLICANT Mpg �Y� X~ 13USINESSIAGENCY 1 <br /> ADDRESSVr� <br /> PHONE 24 • FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 14 Rn:siness clays from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4Aa►-,>qJ,A—�f.s►.Ive_lr j BATE <br /> Y <br /> FILE ADDRESS THIS SIDE EHL)STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> CK=e t- <br /> Mc. <br /> I <br /> 0 C. 3.5.a9 d9.Go <br /> 1 ---- — <br /> , k ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1rUNDEFGROUND TANK(UST)'CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACRM <br /> OTHER CLEANUP SITE{PION-LOP) © FOOD FACILITY 10 SOLJO WASTE VEHICLE <br /> UNVLRUKOUND TAHK(MONITORING OVAL) ❑ DOG KENNLL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR D CHICKEN RANCH Q PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL © PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTO(YRODY PEIRCiNG ❑ POOLiSPA LAND USE APPLICATION SITES <br /> O MEDICAL WASTE fACIL[TY gWuik CtxWAi�SYSTEdI : 1�1 OTHER(T'LI=ASE SPECIFYABOVE) <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 boxes). At least one file typo MUST"be selected. Fax to(209)464-0138 or mail to tbQ <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$81.00 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 /> RFvir-iwFn YP.R lith RR1/1r-W nA'rF <br />