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SAN JOAAUN COUNTYPUBLIC HEALTH SE CES LHULUGNUMUL1! ` <br />ONMENTAL HEALTH DIVISION J <br />Ery / 1 <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT_ BUSINESS/AGENCY <br />ADDRESS ZO 'SV' it- 12,0 <br />PHONE C rC O) i �{ — �7l) D v , FACSIMILE <br />CNS K__ <br />A1Ur aJt,i CA -',-1Sv.2_ <br />i,)) ­7gt '-61gcl <br />TENTATIVE* APPOINTMENT DATE TIME <br />(Please give 7 to 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $78.00 FEE —RE <br />SIGNATURE OF APPLICANT <br />PROCESSED IN 3 BUSINESS DAYS <br />DATE 3J 13/ Z,w J <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ <br />0 <br />FOOD FACILITY <br />DOG <br />❑ SOLID WASTE VEHICLE <br />❑ <br />KENNEL <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ TIERED PERMITTED FACILITY <br />❑ <br />CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TATTOO/BODY PEIRCING <br />❑ <br />-0 <br />MOTEUHOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ <br />POOUSPA <br />/01LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY <br />❑ <br />PUBLIC WATER SYSTEM <br />ZIOTHER (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 <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 FH.D staff may not be immediately available for review. A new <br />application may be submitted when the f' 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 />'iQ ONFIRMED APPOINTMENT DATE <br />�IRMED <br />r <br />00 <br />ill <br />/ <br />r/I <br />YES NO <br />TIME <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />