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SARI JOA^IJIN COUNTYPUBLIC HEALTH SERVICES <br />E IRONIVIENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STdCK7ON CA 95202 <br />(209) 468-3420 <br />> PUBLIC RECORDS RELFASE APPLICATION <br />Ami" f -1 : �A'1 C A e_i U_ <br />APPLICANT Akkbff:.{ C�b� BUSINESS/AGENCY -CAM 6y"'2"t <br />ADDRESS 2.-l0 1�erk.iy�s Sir�c��-a i?v'1om CSA 9'5' b o <br />PKONi~ (—[ a 933�,$ FAGSIiY1lL1= rZ - {o {:r CQ <br />TENTATIVE- APPOINTMENT DATE WCGt� 24 TIME IC 0 d a$AA_ -.I lu Z <br />(Pleass give 7 to 1D business days from date of application submittal) <br />Eal"CRECK BOX TO EXPEOiTE REQUEST . $87.00 FEE - REQUEST PPOCESSr=D W 3 BUSINESS DAYS (� <br />SIGNATURE OF APPLICANT j�'� DATE <br />FILE ADDRESS THIS SIDE EMD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />A1Q.C.O ID °SOl <br />cE <br />euro+ -i Q -361 West rf_4 emr*% l.n,-t. L...ad L <br />l)L1 atrvlav� <br />4-ok jt4,ir-ci- K,e*lemr.n Lzr►a L.dd: <br />I <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />L2 UKDERGROUND TANK (UST) GEFANUP SITE (LOP) F -I HOUSING ABATEMENT ❑ souo WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) Q FOOD FACILITY ❑ 501..Ii) WASTE VEHICLE <br />C1 liNDI:RGROUND TANK (MONITORINGIREMOVAL) D COG KENNEL ❑ DAIRY <br />C HA.rAPPOUS WASTE GENERATOR C2 CHICKFN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMnTEO FACILITY Q MOTEUHOTEL C] PUMPER TRUCWYARDICHEMTOILETS <br />C; TAT O01B00Y PEIRCING Cl POOLISPA - • Q LAND USE APPLICATION SITES <br />❑ MEVICAL WASTE FACILITY C PUBLIC WATER SYSTEM d OTHER (PLEASE 5PECIFY AS OVE) <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 CRUST be selected. Fax to (209) 46+4.0138 or mail tc the <br />address. indicated abgvo. <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 i5 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 $87.00 deposit prior to review. <br />S. "TENTATIVE appointment dates must be confirmed With EHD staff. <br />6. . Applications received after 3:44 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWCD YES NO REVIEW DATE <br />rx ee ,A <br />J Un <br />Q w <br />LLI CD <br />y w <br />LL I C_,-) <br />u w <br />z °- <br />w <br />IUIHL t'.Ul <br />