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04/10/03 THU 10:02 FAA 925 253 4985 - TREADWELL & ROLLO <br />�1J SAN JOAQUIN..COU� r rl�pl,I� — EHo�OGfIIIAI]El! <br />w HEALTH SERVICES 1 <br />APR 1 0 2003 ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR ' I� <br />=NVIRONMErd i HEALTH 5TOCKTQN CA 95202 <br />�I <br />�E4�1iT/SERVICES (209) 463-3420 F+1�= 1=; � �.� -�4zz- <br />PUBLIC RECORDS RELEASE APPLiCATION <br />APPLICANT morin c, H <br />BUSINESSGENCY Tre��i.�.lrAi;_ <br />ADDRESS •� ( <br />PHONE, tI9C� X F CSIM{!~E <br />RZ <br />l — <br />t��-1 <br />-���- <br />TENTATIVE" APPOIN-rmemT DATE <br />(Please give 770,1-0 buslnoss days <br />u CHECK BOX TO EXPEDITE REQUEST 9.00 FEE •- <br />j SIGNATURE OF AE PUGANT <br />3 TIME _ 0�0� <br />nm chin of appllvatlon subrnlllall <br />0 SED iN J BU IN S iAYS <br />.�lip, <br />i <br />•_ <br />y. . <br />w • � I y <br />ENVIRONMENTAL HEALTH DIVISION FILE:3 <br />UNOERGROUNO TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />0 FOOD FACILITY <br />LI 51;11-10 WASTE FACILITY <br />❑ SCILM WA51'15 VEHICLE <br />UNDERGROUND TANK (MONiTORiNC4REMOVAL) . <br />0 DOG KE=NNEL <br />D DAIRY <br />HAZARDOUS WASTE GENERATOR <br />Q CHICKEN RANCH <br />.0 PIi:G TREAi'MENT PLAW <br />YIERED PERM17TED FACILrrY <br />D MOTFLIHOTEL <br />❑ PUMPER TRUC,KIYARDfGHEM TOILETS <br />O TAT7001800Y PEIRCING <br />❑ P00LISPA <br />❑ lJND USF_ API'LICAT10hl :[TES <br />O MEDICAL WASTE FACILITY ` <br />0 PUBLIC WRYER SYSTEM <br />O OTHER tPLE.ANI: SPECIFY ABOVE) <br />1. Ust up to ton addresses In the space above. Select the type(s) of fili;s from thin list above by checking <br />the appropriate box(es). At least one file type MUST bo selected. FaX 16 209 4154-0138 or mail to IlLe <br />address indicated abbye. <br />2. EHD will notify the applicant If any 1=HD files exist. An appointment i'or review will be confirmed <br />approximately five business days but ho later than ten (10) days aftor rrceipt of applic�tioh. The Ides <br />will be held for a maximum of five buslriess days for review. Appolntm ants should be schaduind <br />accordingly, ti <br />3. A file that.ts actively blrinu worked on by EHD staff may not he immediately available for review. A new <br />application may be submitted when the file is available. <br />4. Any file not returned ih the same condition as reluesed will be reorganized by J`HD staff at the expense <br />of the applicant. Future file reviews by tho same applicant may require.? $89.00 deposit prior to rt view. <br />5- "►ENTAT7VE appointment dates must be confirmed with END staff. <br />.6. Applications received after 3:00 pm will be processed the next busihes;; day. <br />CONFIRMED APPOINTMENT DATE. TIME <br />DATE CONFIRMED RHONE FAX INITIALS . <br />REVIEWED YES NO REVIEW DATi: <br />01:, 4.dfi Tb 'OT 7GIM7/7T/TT <br />