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"AIILI< <br /> SAN J( lUIN COUNTYPUBLIC HEALTi� \JIC <br /> ENVIRONMENTAL HEALTH DIVIS:0N <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOGKTON CA 95202 MAY 16 2000 <br /> (209) 468-3420 .., <br /> 0 <br /> {/\ 11. 'iJ <br /> MEi`ITAL HEALTH <br /> J 1 PUBLIC RECORDS RELEASE APPLICATI� F r <br /> APPLICANT t' ' ( � j '� BUSINESSIAGENCY 4h <br /> ADDRESS <br /> %\ <br /> PHONE_C� ! �/ �y FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please Hive 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE_REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT, DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> IJNDERGROUND TANK{UST}CLEANUP SITE(LOP) El HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 'OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY ]a SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL E3 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY n PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE) <br /> I 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 /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE ' <br /> Ek 00 14 02/24700 -°r <br />