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.....,c 1--r-;WE,, I'll L'JG fiU IAL.cil <br /> SAN JC' -WIN COUNTYPUBLIC HEALTH SF--VICES <br /> 1VIRONMENTAL HEALTH DIV[Sl �u �^ <br /> 304 EAST WEBER AVENUE,THIRD FLOOR C� <br /> Ute• STOCKTON CA 95202 J <br /> (208)4663420 <br /> j PUBLIC RECORDS RELEASE APPLICATI }r=',,t,:1 <br /> APPLICANTfine- Sfj BUSINESSIAGENCY <br /> ADDRESS 2%37 ` -S!`''!� .� �,S.�T �L V <br /> PHONE <br /> .. `?' <br /> FACSIMILE `-'' " .•r_c • <br /> TEiVTAT1VE"APFOINTb1V-' DATE I �! TIME <br /> IPlaase give 7 tG 10 bualn •s days from date of app]icatlnn sufamiRaO <br /> 11-rL <br /> CHECK 60X10 E XPL-o1TE REQUE 7&.00 FEE—REQUEST ROC SSED IN 3 aUS;NES&DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> i <br /> FILE ADDRESS <br /> rr r~ a 9 S3 <br /> minerlr � <br /> ! e <br /> ENVIRONMENTAL HEALTH DIVISION FILES l <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M I10U51NG ABATEMENT 0 901-I0 WASTE FACILrrY 'f <br /> OTHER CLEANUP SITE(NON-LOP) EI FOOD FACILITY ❑ SOLID WA$TE VEHICLE � r <br /> QNDERGROUND TANK(MONITORING/REMOVAL) -C7. 000 KENNEL EI DAIRY <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH 173 PKG TREAYMENT PLANT <br /> TDI AEP PERMITTED FACILITY 0 MDTELlHOTEL 0 PUMPER TRUCKfYARDICHEM TOILETS <br /> 0 TATTOOfBQQY PEIRCING Q POOI..ISPA 13 LAND USE APPI(CATION SITES <br /> 0 MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ID OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tort addresses in the space abOVO. Select the type(S)of files from the list above by chocking <br /> the appropriate box(es). At least one file type MUST be Selected_ Fax to 2U91 464-0138 or mail to the <br /> ;Idclre indicated above. <br /> 2. gHD will notify the appll"nt if any END files exist. An.appointment for review will be confirmed <br /> approximately five business'datys 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 f lethat is actively being worked on by EHD staff may not be immediately available for review. .A new <br /> application may be sub'mitt�d when the file is available. <br /> 4. Any tile 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 $78.00 deposit prior to review. 3 <br /> 5. ,"TENTATIVE appointment dates must be confirmed with EHD staff. J <br /> 6. Applications received after 3:00 pm will be procassed the next business day. 4 <br /> CONFIRMED APPOINTMENY DATE TIME 4 <br /> DATE CONFIRMED PHOME. FAX INITIALS _-- <br /> I <br /> REVIEWED YES NO REVIEW DATE <br /> ENO 14 WMAU <br /> I� <br />