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01/07/2002 16:07 2094577 " Niat slocKlo., <br /> / EHU LOU NUMBER <br /> RECEIVED <br /> EIYFD <br /> ,IRE SAN JOAQUIN COUNTYPU13l-lC HEALTH SEK410ES <br /> C ENVIRONMENTAL HEALTH DIVISION <br /> L) 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> il <br /> yl7 iod6a ESAGENCY <br /> /• <br /> APPLICANT <br /> ADDRESS 4 <br /> PHONE eFACSIMILE <br /> TENTATIVE'APPOINTMENT DAYS <br /> �D JTIME /A) <br /> (Please give 7 to 10 business days(r m date of application submittal) <br /> CHECK BOX TO EXPEDITE REOU ST-578.00 FEE—REOUE T ROCES ED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> PILE ADDRESS <br /> L at4 it <br /> S.- 3 <br /> O <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(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ CHICKEN RANCH 13 PRO TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR p MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEMTOILETS <br /> TIERED PERMITTED FACILITY ❑ POTELIHOOLJSPA LI LAND USE APPLICATION SITES <br /> ❑ MEDICALTATTOOISODY <br /> WAS TEF C FACILITY <br /> ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <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 th <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 $78.00 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 /> ECONFIRMED <br /> POINTMENT DATE TIME <br /> PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> EH <br /> 00 14 010900 - <br />