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ITE RECEIVED EHD LOG NUMBER ��y& L/ <br /> SAN JOAO' I COUNTYPUBLIC HEALTH SER' 'ES / <br /> EN�ONMENTAL HEALTH DIVISION <br /> G <br /> WEBER AVENUE,304 EAST,, <br /> STOCKTON CA 95202, 't_ 1VEU <br /> D FLOOR <br /> (209) 468-3420 <br /> DEC 2 7 19!PUBLIC RECORDS RELEASE APPLICATION <br /> ENV i l:40 iii :' -FH <br /> PPLICA <br /> USINESS/AGENCY <br /> / ] <br /> DDRESS �TI �,C�t 1�j C'�� (� I (r / �Gl�`� �� �� ���' �''.L� 1 <br /> HONE 00') U �L� �� FACSIMILE \ �ry� / y ('�' �� <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> HECK BOX TO EXPEDITE REQUEST-$7 .�F E—R UEV <br /> /ROOC/ESSE-D 3 S ESS DAYSR LUSH <br /> GNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> 4 <br /> �EhLVJIAN HEALTH DIVISION FILES <br /> F-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> COTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> I TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 1 TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> 1 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 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 /> 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 /> 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 /> 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 /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> i. Applications received after 3:00 pm will be processed the next business day. <br /> �^.-., . , .ems ��+•. t �' `�'f"r.".i'�'t' Y'..'. E. 4� r t .. -Q.d �'r 1 ti"�,"k' ...'l .. <br /> ONFIRMED;APPOINTMENT'.DATE*#` 'r��r ��.1�x:Wr,�,�`�.,,,` k��•ys�,�..� `:t�,?,TIME�>`.;f� �, 3,� ��t,Yy�w-,a =�r rws•Y;,53a<�#:=�"} e,s� �; <br /> .rtht t 4" ter.. ..rt yya r {,».moaneAr�'"' >^ t •'x; .,,e y+•b4 �•z'4_ <br /> _ f t F.?.'•tfi 'Y '' f .,, 1 f� a.k t r R ^,*.S-/'St N` *Yx T, a !y t <br /> 1� 3" L 'r Af �� � rs <br /> c :-Y_.1•:.r.i�. ..'::� �''t ,yt"� '.'}3�a i'L- Z.i' r'r rpt�t' M,j ��{ r.. yr" flsi }'F� .�}�'° <br /> )ATE CONFIRMEDPHONE" _•. 1 FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> /30/99 <br />