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SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ,, ANO�OGNUMBER <br /> ENVIRONMENTAL HEALTH DIF ION <br /> 304 EAST WEBER AVENUE,THIRD F�CbOR <br /> STOCKTON CA 95202 <br /> (209)468.3420 ,JUL 112002 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTrtl n&-d �j BUSINESS/AGENCY �T�c Ti,�J;,n ; P s <br /> ADDRESS ` 'Cc-e-t- <br /> PHONE ���� - .��i( FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Pleasegf a to 7 busing ayy dateof application submittal) <br /> 4 <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE- EQ ST PROCES DIN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE -'- <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ,�ADG0bv% S I LC.I 3003 <br /> (i0 <br /> 3-61 Y 7 <br /> r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> KUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> I ( UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM '7C OTHER(PLEASE SPECIFY ABOVE) <br /> E e- <br /> 1. �fc+� res pvy <br /> List up to ten addresses in the space above. Select the type(s) of files from the list above byJahec ingelc,�. <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to he up <br /> address indicated above. I -- - <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 worsted 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 $89.00 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 /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED_ YES NO REVIEW DATE <br /> ,g T.pnr <br />