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LAI L-kLGLIVLU <br /> E >� , EaN J Ea'_'N COUNTYPUBLIC HEALTH S.'~"'°+.CES LNU LUG NUMl3tR1! RONMENTAL HEALTH DIVISIOW- <br /> .�� ��Q� 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 1E ALTH (209) 468-3420 I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT L]! l!< --0 !/ -^ BUSINESSIAGENCY S-t0e— ?2 i e;�4 rr 4 or/%, �I <br /> ADDRESS 07f1 C <br /> PHONE.._,�ZO`l-7 9`l- �LSj rj FACSIMILE .2O',Ft-7`F41;2L S,2 <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) , <br /> CHECK BOX TO EXPEDITE REQUEST-$7 00 FEE EQU T PROCESSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ad <br /> FILE ADDRESS <br /> I <br /> r <br /> AF— <br /> Y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP_SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA *SAND USE APPLICATION SITES it <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM �j 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 I <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 /> ( <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED r YES NO REVIEW DATE <br /> EH 00 14 01105/00 _ <br />