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rktR9 Gra <br />V <br />APPLICANT <br />PI N.i. . .2LiJ U.: U _ 1. .., -Ji,1 � . -': u . i i <br />SA`AQUIN COUNTYPUBLIC HEALTH SE1- ACES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />sYOCKTON CA 95202 <br />(299)460,3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS I I I "r r 1 rp V+ L5�'ir�`C�� <br />PHONE 20 U 3 O ( S TO <br />0W Lin. ;' :MJL+ <br />, / YA <br />eke VL -V -j 2e�0 Sis <br />CA `I s3.:Lca <br />TENTATIVE'APPOWTMENT DATE Jb a bl TIME IQ_ h. <br />.. {Plooa. pi»r 7 to SG bu6:. bac aers rma dak of aPpiiralton ivamEtaq • <br />13 4[''{/' <br />CY.ECK BOX 70 EXPiiO.iE REl}UEBT - STB.Oa FEE QUEST PROCE99Eu 1N 7 BUSINESS GAYS UJ <br />SIGNATURE OF APPLICANT C E Ip I p <br />— DAT <br />ar�a�w� • �ilil� �� <br />r <br />II�I��r n <br />welfi,1kill IIUN- 11f;7111� <br />J•InitlltVlll/i�'14'11` -Z"a� <br />l�!•� Z <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK(USTJ PAANUP 3472 (LOP) Cl "OUSUIGAZAT_NENT .7. SOLIDWASTE FACILITY <br />MPA CLEANUP SIT: INONtOP) 0 FORD FACILITY G SDLID WASTE VEHICLE <br />UNV=-RGROUNDTANK;MONITOjUNajREMOVALJ .7 DOG KENNEL CDAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CKICNEMRANCN O pKG TREATMENT PLANT <br />TIEVLD Pi:M-T-En 7A=ny ❑ MOTEV1107EL 6 PKG TRE Tl MEN TPLANT E7d TC$.ETS <br />C TA7700 OVYIVAS PCIRCBiG D POOUSPA .^+ LAND USE APPLICATION SITS& <br />7 MEDICAL WASTE FACI:JTY 0 LAND <br />� OTHER {PLEASE SPECFy ABOVE) <br />t. J,ist up to ten addresses in tele Space above. Select the typx(s) of files from the list 2Luve by cheewng <br />the appropriate box(e,S). At feast one File type MUST be selected. F to 64 or mail to the <br />aAdrjX3 JnOirg d above <br />2 EMD will notify the applicant if any EHD fl!es exist An appo;ntment for review will be confirmed <br />approximately live bUsineSS days but no later than ten (t 0) days after receipt of application, The WL" <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 actJVefg being worked on by EHD staff may not be frnmediatsfy available for review_ A new <br />application may he submitted when the file IS avaihb!e. <br />4. Any fife not returned In the same condition As released will be reorganized by EMD suit at the expense <br />of tht applicant Future file reviews by the same applicant may require a $70.00 deposit prior to review. <br />5. `TENTATEVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:90 pm w;U be Processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />OAYE CONFIRMED <br />TIME <br />PHONE FAX <br />REVIEW <br />INITIALS <br />TOTFL P.01 <br />