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SAIN JOAQUIN,COUNTYPUBLIC HEALTH ERViCES <br /> FED) 4' ENVIRONMENTAL. HEALTH DM <br /> LL- 0 304 EAST WEBER AVENUE,THIRD FLQ R <br /> STOCKTON CA 95202 -IF 'C <br /> J U L 1 1 I 11 u 1 (209) 468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APP�ICA.HT r �j5 �1, f� �BUUSIME=AGEEN�yCY <br /> PHONE <br /> 1B <br /> TENTATIVE*APPOIWTNENT PATE nmE' egh R'a <br /> (Please give 7 to 10 business days ft4att date of apptiaatlort su6mitXal} <br /> ]�j uv:rs 3; �-� <br /> �+ CHECK BOX 70 EXPEDITE FtEQUf"S7-$7 d FE1=-R VEST PROCES R IN 2 BUSINP,Ss DAYS <br /> SIGNATURE 01=APPLICANT - DATE It � <br /> \ FILE ADDRESS <br /> V <br /> o tj ' <br /> I.►FF <br /> E. <br /> rya+ <br /> �P- v CS6vu U61 11 Irin <br /> ` PI1ti.. <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 ROUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHI=R CLEANUP SITE(NON-LOP) Q FWD FACILITY O SOLID WASTE VIcHICLIE <br /> WIV UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL Q DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH M PKG TREATMENT PLANT <br /> M TIERED PERMITTED FACILITY 0 MOTELIHOTEL Q PUMPER TRUCKIYARDICHENETOILETS <br /> 0 TATTOOfBODY PEIRCING d POOLlSPA 0 LANE)USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUMJC WATER SYSTEM d OTHER 9n.EASE SPECIFY ABOVE) <br /> I. List up to ton addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate boxies). At least one f[Is type MUST be selected. Fax to (209)464-0138 or mail to the <br /> a�idrgss indicated�boys. <br /> 2. EHD*iII 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 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 salve 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YI-S NO REVIEW DATE <br /> Eli 00 14 GIMMo <br />