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SAN JOAQUIN COUNTY u <br /> E! 'RONMENTAL HEALTH DEPAR" ANT <br /> ~304 EAST WEBER AVENUE, THIRD FLO'ZrR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> �+ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTC Co[c 10091 In BUSINESS/AGENCY �itMt S LlG Uy <br /> ADDRESS <br /> PHONE OCA 0 3 . FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 busines6'days m date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUES F —.R EST P ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> t <br /> r� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Y L-. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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 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 $89.00 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 G PHONE FAX INITIALS <br /> REVIEWED S NO REVIEW DATE <br /> EHD 48-02-006 <br /> 3/26/2003 <br />