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erro wa NUMeta <br />SAN�AQUIN COUNTYPUBLIC HEALTH -RVICES <br />ENVIRONMENTAL HEALTH DIVI!5'10N 0 J <br />IOST S OCKTONER ECA 95202�D FLOOR <br />(209) 468.3420 <br />F E B 213UUIC RECORDS RELEASE APPLICATION <br />APPLICANT ` L ii `LTH BUSINESSlAGENCY�LLJ In(lOad (pnC fjnr,, l4 <br />ADDRESS <br />PHONE _ 4 lL, - Iota 7 ,,;1 r L, -.D FACSIMILE 416 —1352 -7f *3D <br />TENTATIVE" APPOINTMENT DATE Z ZE&Ii0 TIME I S M <br />(Please give 7 to 10 business days from date or application submiltal) <br />HECK BOX TO EXPEDITE REQUEST - $78.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT JA08A&n DATE _ _ b „q-20:;AO <br />�. i�,l.ls • •+ 1. i+ a _ �_- <br />r��r <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />W UNDERGROUND TANK (UST) CLEANUP SITE (LOP) Q HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />❑,PT}LER CLEANUP SITE (NON -LOP) d FOOD FACILITY d SOLID WASTE VEHICLE <br />MFUNDERGROUND TANK (MONITORINWREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />f7 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIEREHAZARD ER ITTEDE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br />d TIERED PERMITTED FACkUTY <br />❑ TATTOOJBODY PEIRCING ❑ POOUSPA CI LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACKM ❑ 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 249 464-0138 or -Mail to the <br />address indicat above <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 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 frame condition as released will be reorganized by EHD staff at the expense <br />of the applicant. Future fite 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 prn will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE I TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />Eli W 14 SIMS o <br />