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u1/b7/2bb2 i6:bj 20946711< AUL SIUCKIU .` i`,-% ic- L-jU� <br /> uiai c�scuuveu � III LOG HUh19IIt <br /> SAN JOUIN COUNTYPUBLIC HEALTH S ICES <br /> SENVIRONMENTAL HEALTH DIVISION 344 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 f3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 4 APPLICANT BUSINESSIAGENCY �l I <br /> ADDRESS Q <br /> PHONE ��1 (� ! !1/�ICJ. _ F CSIMILE <br /> TENTATIVE"APPOINTMENT DATE ` C r t I 1 TIME !L�•� <br /> (Plsaao give 7 to 1 busirless days from date of application submittal) <br /> �ti1775 -_-?, e,4 <br /> CHECK BOX TO EXPEWTE REQU578.00 FEE–RE UST PR CESSED IN 3 BUSINESS HAYS <br /> SIGNATURE'OF APPLICANT7DATE <br /> FILE ADDRESS <br /> r t <br /> of <br /> Jr �r <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORIN GIREM OVAL) ❑ EOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATQR O CHICKEN RANCH ❑ PKG TFZEATMENT PLANT <br /> TIERED PERMITTED FACILITY C7 MOTELIHOTEL 0 PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTOOISODYPEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY CJ 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 (2Q9)401-0138 or the <br /> 'a r s indlcat d v - <br /> 2. EHO 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 returri"ed 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 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 UO 14 Oliu=a <br /> • <br />