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.!i41-11. .l.YLt1 <br /> OIU I,pG iNMBEi! <br /> SAN , AQUIN COUNTYPUBLIC HEALTI 'ERVICES <br /> v <br /> ENVIRONMENTAL HEALTH DIVIMN <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT z ( <br /> BUSINESS/AGENCY.CY yL I/1 c vt U i <br /> ADDRESS C 7- Cr n a <br /> PHONE f - !� FACSIMILE , <br /> TENTATIVE' APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of application submillal) <br /> CHECK BOX TO EXPEDITE REQUEST-$09.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I 2- 0.2 <br /> ' <br /> FILL ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> s riv- r� c <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE (LOP) CI HOUSING A13ATEMENT o SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL_ 0 DAIRY <br /> a HAZARDOUS WASTE GENERATOR n CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMMED FACILITY d MOTEL1HOTEL 13 PUMPER TRUCKIYARDIGHEM YOILETS <br /> 0 TATTOOIBODY PCIRCING .0POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY Ci,PUBLIC WATER SYSTEM 0 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 4G4-0138 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 ton (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 ih 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 /> G. 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 />