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I L I:LULI V UU LI W LUG NUMULN <br /> EE V S�' N JOERONM NTAL HEALTH D VISIO�ICES 00—OA <br /> -)i�,,,P 304 EAST WEBER AVENUE,THIRD FLOOR <br /> JAN 24 2000 STOCKTON CA 95202 <br /> ENVIHONNIENTAL HEALTH <br /> (209) 468-3420 <br /> e1-1- / cFR /ICFS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r r r - BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> a5c:,a- Da0',Y1C.f rl V--9 <br /> DO L-01,0 00A - <br /> �U <br /> ! ' p <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1 (A-vo4— <br /> ❑ UNDERGROUND ANK(UST)CLEANUP SITE(LOP) ❑. HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> El UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED.PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 (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 /> EH 00 14 01105100 <br />