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Q <br /> aA1t HLCU`/1:u 1110 UA.NU6'ULH U ttVV�r//jj <br /> SAN JOA4UIN COUNTYPUBLiC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 3U4 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 l'' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT i DY 7 ! �'n/fig BUSINESSIAGENCY <br /> ADDRESS ��ji��'D� <br /> PHONE �D�'S�s J o•57 2L-: �F�AC�/SIM/IILLpE <br /> TENTATIVE'APPOINTMENTDATE Di////,Vo/ TME <br /> (Please give 7 to 10 business days from dale of application submittan <br /> CHECK BOX TO EXPEDITE REQUEST-$87.60 FEE-REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN S� ��� — DATE a/o6�j t�of <br /> FILE ADDRESS 'THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 77 Ssi._ _p7T�. r'So f35 S _. 27 _. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> yr UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) R'F000 FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGtREMOVAL) ❑ DDG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY D MOTELHOTEL ❑ PUMPERTRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBOUY PEIRGING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICALWASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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. END 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$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. 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 />