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u,"26/'Uy s '.I z:os FAX` "r (: )( [it 002/00: <br /> �/ � SAr�I <br /> ENVIRONMENTAL HEALTH Dl%� • �ERViCES <br /> .. i N <br /> 304 EAST WEBER.AVENUE,-THIRD FLOOR <br /> AUG 2 8 2003 STOCKTON CA 95202 <br /> (209)4683420 <br /> E UNMEtgT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERW <br /> APPLICANT _� BUSINESS/AGENCY Deffn <br /> w — <br /> ADDRESS 11044 VADAd Irv► VY S n �V1 b Cbrdwot. , 1 <br /> PHONE 34 FACSIMILE 8 3 VS <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUES $78.00 FEE,R E T PROCESSED IN 1 BUSINESS DAYS UP <br /> • <br /> SIGNATURE OF APPLICANT DATE XF a3 7c1 <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Q <br /> J ' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Cl THER CLEANUP SITE(NON-LOP) C3FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILET <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY C] PUBLIC WATER SYSTEM ❑ 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 check <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to tt <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 fib <br /> Will be held for a maximum of five business days for review. Appointments should be scheduled <br /> r„ accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A iv <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 expe <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to rev v. <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 CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED. YES NO REVIEW DATE <br /> EM 00 is 01121100 <br /> - - TOTAL P.02 <br />