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lU/0U MDN 1G:1R FAX 26139�)6EL <br /> �'IJu[�2 J <br /> brw;i:SritiN'lu <br /> Tu 1f0EN•DeNMB9. P.0.4 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> -AUG;2:9 2000 304 EAST WEBER AVENUE,THIRD FLOOR IMP-. .•,. n. <br /> ENVIRONMENT HEALTH sTOCKTON -3 s52020 <br /> (los)as(ta4so =G <br /> __pFRMLR ICES PUBLIC RECORDS RELEASE APPLICATION t <br /> x <br /> APPLt� LI Of � <br /> •,w.{ . <br /> B1161NESSlAGENGY y ,.:�.. <br /> FACsIMu.E a r 366 <br /> i <br /> TtNTAT1VE'APPOINTM[NT DATE TIME <br /> (PICA"give 7 to 70 bu.iia days from clad.of appacadon submittal} _ <br /> ' ,CHECK BOX TO EXPEDITE REQU/E/Sz/j,smo �-RE�UUFST PROGESIED IN 3 BUSINESS DAYS ! <br /> SIGNATURE OF APPLICANT '"` /7LIXf DATE <br /> FILE ADORESS <br /> W L� <br /> Z _I'Y. <br /> 2 0 ; ,f, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOU8I03 ABATEMENT Td UOUD WASTE FAGILRY <br /> OTHER CLEANUP SITr(NON-LOP) 6 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> �t UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DDOKENNEL 7d DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH X PKG TREATMENT PLANT <br /> $t TIERED PERMITTED FACILrrY d MOTELIHCr EL J'PUMPER THUGUYARWCHEY TOILETS <br /> ❑ TATTOO/90DY FORCING ❑ POOUBPA )4 LAND USE APPLICATION SrTE9 <br /> ❑ MEDICAL WASTE FACILITY O PUULIC WATER SYSTEM O OTHER(PLEASE SPECIFY ASOVE) <br /> 1- List up to ten addresses in the space above. $el"t the type(s)of f7es from the list strove by checking <br /> the appropriate box(ea). At least one file type MUST be selected. Fax to (209) 464-0138 or mall to tha 4r- <br /> Rddress Indtoatod 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 flies <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 now <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 sarne applicant may require a $78.00 deposit prior to review. <br /> 5- 'TENTATIVE appointment dates must be confirmed with EHD staff. +I'� <br /> Ir 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 /> I nT!j yED YES NO REVIEW DATE <br /> cn ou �. m <br /> TDTRL P.02 <br />