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tiULL ASSOC 530 633 0119 02/19/03 10:332am P. 001 <br /> + ��7 SAN J0/4"i41N COUNTYPUBL,IC HEALTH SERVICtS' <br /> FEB 1 9 2003 ;, ENVIRONMENTAL HEALTH DIVISION 1 <br /> 304 EAST WEBER AVENUE.THIRD FLOOR <br /> ENVIIIONMENT HEALTH STOCKTON CA 95202 <br /> PERMIT/SERVICES )468-3420 <br /> PUBLIC RECORDS 9RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY� 11Q/Q ii C <br /> ADDRESS <br /> 7 <br /> PHONE O — FAACSIMILE 3� '—�C► <br /> TENTATIVE'APPOINTMENT DATE_ /T S iQ -d <br /> (Please blre T l0 10 business des from date of a TIME ve <br /> Y ppticaUon su0mllbl) <br /> CHECK BOX TO EXPEDrrE RE =89.00 FEE—REQUEST P ED IN 3 BUSINESS OAYS. <br /> SIGNATURE OF APPLICANT A.�. DATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEIUIGH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACJUTY <br /> O ER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> �!�IUxDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> WNAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY D MOTEUHOTEL 0 PUMPER TRUCKWAROICHEM TOILETS <br /> O TATTOOIBODY PEIRCING ❑ POOLISPA '❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUeUC WATER SYSTEM 0 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)4114-0173 or mall 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. Appointmonts should be scheduled <br /> accordingly. <br /> 3. A file that.ls actively being worked on by EMO 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 /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INIT(ALS <br /> REVIEWED YES NO REVIEW DATE <br /> -:0.4 — -- ----� <br />