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err—c�r—�uur� w._-e�•�rrrrcTu .- - <br /> `SAN JOQUiN OOUNTYPUBL,IC HEALTH *V1cES <br /> ,! <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �r <br /> a" 304 EAST WEBER AVENUE,TI41RD FLOOR �s <br /> STOCKTON CA or,203 C' <br /> (200)468.3420 � ��. ! VVE <br /> PUBLIC RECORDS RELEASE APPLICATtC�N tom , <br /> APP'UCANT AUS1144=0 GEIICY r �- ranC <br /> Amass Z : C)I 1E TH <br /> PRONE " 7 E <br /> FRC3IM11I_E �� ... <br /> TP-AITATIVE'APPOWT uENT mATR TIME _ <br /> (Plaa6e Ove 7 w 10 bus+inew days from date of aPPllcatllsn submitral) <br /> CHECK BOX TO EXPEDITE IK9QU -87 .00 FEE—REtuiBaTPROC SSED IN 3 Busmrms jDAYS <br /> SIGNATURE OF APPLICANT _ DATE <br /> FI AOORESS 7W11S$IDE N-D STAFF 1.I NLY <br /> PF=31AN ELE7MNTB SEARCs<I <br /> DEAc. an <br /> C " GtS fe 5( b,' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNO7=RGROUND TANK(UST)CLEANup SITE(LOA) In HOUSING ABAT,*?4FN TSOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 SOLID WASTEVBHIcW <br /> UNDERGROUND TANK 040NI'tORINWREMOVAL3 C3 DOG KLMNEL M DAIRY <br /> HAZARDOUS WASTE Q$NEItATIOR O CH=E-N!RANCI'1 ❑ PKG'I SAT7i ENT PLANT <br /> TIERED PERMITMO PACIUTY C3 L11 TEUNOTEL ❑ PUMPERTR(1CMAF1bXtmM TOILETS <br /> C3 TATTOO1B0D1r PEIRCING ❑ POOUSPA ❑ LAND USE APPLIC^YICN SITES <br /> CJ MEDICAL WASTE FAGILTTY ❑ PUBLIC WATER SYSTEM C3 OTHER(PLAASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(S)of files frvm the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. ,&x..fo MPS)464-0138 or mail to the <br /> address Indlc -ateabove. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be Confirmed <br /> approxlmatety flVe bualness days but no later than ten(1d)days after receipt of eppficatiorl. The files <br /> will be held hir a maximum of five buzinass days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately available for review. A new <br /> application rrnly be submitted when the file is avallable. <br /> 4. Any file not returned in the same condition as released will be re*rgaslb and by IEHD sfAft at the expense <br /> Of the aipplicant. Future file reviews by the same applicant may rmquire a$78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed vrlth EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the newt business day. <br /> CONFIRMED APPOINTMENT DATE LIME <br /> DATE CONFIKMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> iM as s� 6Slp+b� <br /> TQTAL P.02 <br />