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SAY 'OAQUIN.COUNTYPUBLIC HEALTH ERV1CcS <br /> ENVIRONMENTAL HEALTH DIVi;,...J- _ <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> �i 1 2(] j STOCKTON DA 95202 Z g <br /> (209) 468-3420 <br /> EiN1`�'r �'�' �'✓1E1� "EA_Ll-H P PiLIC RECORDS RELEASE APPLICATION <br /> n� <br /> APPU.CAN QJ <br /> S <br /> ,j V&--E NESSIAGENCY djdg CjeJ K� zIJ �aC' <br /> Oda CLA"ADDRESS O U /-/S <br /> PtIIJN y ^i - FAGS MILE D - 7'[A 2 <br /> Fe,9 ;GTir N1TATIVE"APPOINTMENT DATE_ Q4 T11AE <br /> (please give T to 10 bu5inesd days from date of applieatloA submittal) <br /> -CHECK BOX TO EXPEDITE REQU - 711013 FEE-12!`QUE PROGESSFD IN 3 BUSINESS DAYS ' <br /> SIGNATURE OF APPLICANT DATE <br /> IV <br /> FILE ADDRESS <br /> JI'I'lQ <br /> 1 9 <br /> o� a <br /> Qi -— <br /> F. / ! <br /> Dd ShV (' n <br /> ag.G o NK_ <br /> t <br /> a,ft o5n��5 UAS� <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> l <br /> *UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT L7 SOU*WASD L <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACIL TrY ASTE VEHICLE <br /> XUNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> >C'HAZARODUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLAINT <br /> ❑ TIERED PERfArn ED FACILITY ❑ MOTI=LMOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING ❑ POOUSPA LAND DISE APPLICATION SITES <br /> 0 MEDIGAi_WASTE FACILITY ❑ PUBLIC WATER SYSTOM OTHER(PLEASE SPECIFY ABOVE) <br /> 1. Uf.st up to ten addresses in the space above. Select the types) of files from the Ost above by checking <br /> the appropriate box(es). At least one file type MUST ba selected. Fax to (209)464-0138 or mail to the <br /> address'indicated above. <br /> 2. EHD will notify thu 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 EHO 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. 5uture'file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pin will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONF=IRMED PHONE- FAX tN1TIALS <br /> REVIEWED• YES NO REVIEW DATE <br /> RA 55 14 VIfO5A0 ,'•V•.••• <br />