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WAILRLCEIYEU - ..-�"'� ""�•"- �. .-- <br />h <br />w f SAN i0f- "jiN COUNTYPU Ll .14UI�uLj, <br />l/I�� r-j,.�i BLIC HEALTH S�10ES <br />f '7EnIVIRONMENTAL HEALTH DIVISIOfj--- <br />l nem- s <br />n I 304 EAST WEBER AVENUE, THIRD FLOOR <br />vU//J a r rn v� 5 y STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />IV <br />APPLICANT BUSINESS/AGENCY <br />ADDRESS_, <br />PHONE <br />TENTATIVE* APPOINTMENT DATE TIME <br />(Please give 7 to 10 business days from date of application submittal) I <br />CHECK SOX TO EXPEDITE REQUEST. $89.00 FEE —REQUEST PROCESSED IN 3 BUSINESS DAYS <br />—)SIGNATURE OF APPLICANT <br />DATE <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />CI OTHER CLEANUP SITE (NON -LOP) © FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORING/REMOVAL), ❑ LDOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL ' PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOO/BODY PEIRCING ❑ POOUSPA LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FAC14ITY D PUBLIC WATER SYSTEM ❑ THER (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. 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 PHONE FAX: INITIALS <br />REVIEWED YES NO REVIEW -DATE <br />48-01-006 <br />REVISED 12-27-01 <br />