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Lill'LQU�lUln„ll. <br /> SAN J �U1N COUNTYPUBLIC HEALTH RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 0 7 2001 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 ' <br /> L'1 . •_..; ,: :; ,_I�i (209) 468-3420 <br /> =� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ ..� � V� SI-1{4- "_A BUSINESS/AGENCY rec <br /> ADDRESS _ ( I C A 127 S�'2 S'joClcTc7/J C 57-0 _ <br /> PHONE j9_09 3 l 3�,6,L4 FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.0 FEE—REQUEST CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE 6 0) <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1S5 S <br /> E.' c--w►ar T S-1 o Q0 CirJG <br /> LLD <br /> - D <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ h1OTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE 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. 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 .1pplicant. 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 /> 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 /> EH 00 14 00/07/00 <br />