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4J U li, <br /> oATERECElvFP SAM JO ' ° IN COUNTYPUBLIC HEALTH SVICES <br /> E IRONMENTAL HEALTH DlVISIO n <br /> \J 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 1 <br /> (209) 468-3420 . <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT G <br /> BUSINESS/AGENCY 'WLV (EPN LKl>•rJ ro <br /> ADDRESS <br /> 9e� FACSIMILE <br /> PHONE O:: . <br /> TIME _ ° <br /> TENTATIVE'APPOINTMENT DATE Y application submittal) C <br /> (Please give 7 to 10 business Clays from date of app 2 <br /> CHECK SOX TO EXPEDITE REQUEST- 7 EQUEST PROCESSED IN 3 BUSINESS DAYS f <br /> --� DATE f Z Z� � <br /> SIGNATURE OF APPLICANT <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM►ELEMENTS SEARCH <br /> L.AT{Fi2a <br /> gDC"Kn <br /> O <br /> Z � <br /> t <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1:3 SOLID wASTS FACILITYt UNDERGROUND TANK(UST)CLEANUP SITE(I OP) 0 FOODIFACILITYABATEMENT p SOLID WASTE VEHICLE <br /> ❑ THER CLEANUP SITE(NON-LOP) DOG KENNEL 171 DAIRY <br /> UNDERGROUND TANK(MONiTOR3NGfREMOVAL) C1 CHICKEN RANCH D PKG TREATMENT PLANT <br /> O HAZARDOUS WASTE GENERATOR p MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TIERED PERMIITTED FACILITY ❑ pOOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING p PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY <br /> s in the space above. Select the type(s)of files from the list above by checking <br /> List up to ten addresses the appropriate b resse. At least one file type MUST be selected. Fax to (2091 4$4_0138 or mail to the <br /> ox(esaddress indicat2SLgtove. <br /> if any EHD files exist An appointment for review will be confirmed <br /> }2. EHD will notify the applicant <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 its 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 /> L <br /> CONFIRMED PHONE FAX INITIALSEWED YES NO REVIEW DATE <br /> EH 00 14 OZ74/00 TOTAL P.02 <br />