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DATE RECEIVED sHoLOG muwBEx <br /> SAN ][OAQXJIN COUNTY <br />~ || Enn - �NMEAL�1��� 33� ~ O�� ����|�= �T <br /> 304 Weber Ave 3mFloor Stockton, CA. 95205 <br /> 'OCTT -- �7OQ0468-3420 Fax: (7Og) 464-0l38-Wmb: vvvnw.00.s 'n uin.ca.os�hd <br /> ENV\KI 1VEN[ ��-A[]HPITBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: < J2' BUSINESSIAGENCY: <br /> TENTATIVE*APPOINTMENT DATE: <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE QFAPPLICANT - DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 2. Street 9 oty <br /> city <br /> —4. Street C41Y <br /> —5. sveet (-Q-)(j 'V� — 'D Unit <br /> 6. Street City <br /> ON <br /> 7. Street Unit 4 <br /> 8. Street Oty OCI <br /> 9 S�� city F U n�it J5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 11 SOLID WASTE VEHICLE <br /> I&ICCUNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY Vj <br /> ,>afHA7_ARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> o T4nTocxaooYp|Eao/wa o PoouspA o LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY o OTHER(PLEASE SPECIFY) <br /> 1 <br /> List uptoten addresses inthe space above. Select the h/pa(s) offiles from the list above bychecking <br /> the appropriate box(as). Adleast one file type MUST boselected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHDwill notify the applicant ifany EHDfiles exist. Anappointment for review will beconfirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will beheld for amaximum offive business days for review. Appointments should bmscheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. J\new <br /> application may basubmitted when the file isavailable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> mfthe applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must beconfirmed with EHOstaff. <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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHO 48-02-006 <br /> ` <br />