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GATE RECEIVED - <br /> SAN 'AQ COUNTYPUBLIC HEALTiERVICES EMD I�OGNUMBER <br /> ONMENTAL HEALTH DIVISION <br /> Zfl�2 90 <br /> 4 ST WEBER AVENUE,THIRD FLOOR <br /> {�N STOCKTON CA 95202 <br /> (209)468-3420 AM <br /> ENV« MMEN' FI ,LCk PUBLIC RECORDS RELEASE APPLICATIR' U- 1 leo H_ <br /> APPLICANT BUSINESS/AGENCY V tl <br /> ADDRESS jaQ , JQC ' t`k CLS <br /> PHONE 44toJ- <br /> 43a a FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE I 30 02_ TIME f. ' <br /> (Please give <br /> 7//to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-RE Q4ETIZPROCD IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE l �- <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 3S <br /> 1 S <br /> 35a-k- <br /> i <br /> cx <br /> z9 <br /> r 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> " NDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT - ❑ SOLID WASTE FACILITY <br /> I OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Lq' AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ,,HAZARDOUS <br /> PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES, <br /> ❑ MEDICAL WASTE FACILITY 0 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 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 (1'0) 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 $89.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <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 />