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_ _ 7/30/2002 13:48 209467`8 AGE STOCKTON PAGE 02/02 <br /> GATE REGEIVED env�w vwvcn <br /> SAN JL",IQIJIN COUNTYPUBLIC HEALTH SmrNIGES / <br /> IRONMENTAL HEALTH DIVISION <br /> .i. 0 AST WEBER AVENUE,THIR <br /> STOCKTON CA 95202 <br /> 209 46$-3420 -V wo `�� <br /> PUBLIC RECORDS RELEASELI�TR�LTION N l <br /> APPLICANT BUSINESS/AGENCY <br /> ADDRESS (, )l <br /> PHONE R0 / V/0 l tJa6 FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 tt10 busing s da from date of ap lication submittal) <br /> CHECK BOX TO EXPEDITE REQUE -$ 8.0TVEE U RO ()1 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7/3 Q <br /> 17 <br /> FILE ADDRESS <br /> t A 4P11 & <br /> c roe <br /> � o <br /> TU f <br /> t� I< 'c ►' •ind <br /> d <br /> r <br /> T <br /> ENVIRONMENTAL HEALTH DMSION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILrTY ❑ MOTELIHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SfTES <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)464-013$ or mail to th4 <br /> address indicated above. <br /> r 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately rive 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS _— <br /> REVIEWED YES NO REVIEW DATE <br /> e►+ ao t� otmyoa <br />