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SAN J iI:zS <br /> 4MIVIRONMENTAL HEALTH D VISIO**' 7 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR r r <br /> ZQQQ STOCKTON CA 95202 tOw U <br /> ENS HEA�jH (209) 468-3420 <br /> PUBLIC RECORDS c, DS RELEASE APPLICATION <br /> .I1PPL�GANT ' l �.tM-'�•Jt� /�)Ei/ BUSINESS/AGENCY �,44V J�[1[�Lf fTPOENII/YYJh/}4�°� <br /> ADDRESS `7 nn J uJ//ijho Q C IIA 5;RO-S�� . <br /> PHONE �V .-1!L -/I�DY! FACSIMILE � 7 b � -//)[/T� <br /> TENTATIVE*APPOINTMENT DATE ZI-e -(r TIME 0� 0 { <br /> (Pl+ase give 7 to 10 business days from date of application suemittal) <br /> CHECK BOX TO EXPEDITE REQUEST-MPU <br /> -KEE-REDIUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT \ �_ DATE \\ 20 t TDO <br /> FILE ADDRESS - <br /> \ ] C <br /> �I 03 ve <br /> n� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOLID WASTE FACILITY O <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK tMONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY O <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYAROICHEM TOILETS <br /> ❑ TATTOOISODY PEIRCINO ❑ POOLISPA ❑ LAND USE APPLICATION SRES e <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in.the space above. Select the type($) 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 EKD files exist. An appointment for review will be confirmed <br /> approximately f)va 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 LU <br /> accordingly. <br /> 3. A file that Is actively being woriced on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the rite 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 /> S. *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 YES NO REVIEW DATE <br /> W MIA ctlovnc - <br />