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JA 4 J0AtAUIN GUWV I YYULiLIG HtrAL I H�!<ViGES' <br /> \ ENVIRONMENTAL IIEALTII DIVISION <br /> �l 304 EAST 4YE CROON CA 9 202 FLOOR <br /> STOCiC7'ON CA 952D2 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION rn <br /> APPLICANT j yq 441X BUSINESS/AGENCY Ge,7Wart&1C LOcf fN *'wNfA <br /> ) <br /> ADDRESS 2 '/4I�lMn/N Stt fir" 2-/.7 FrrfNn eA -1 �g z� a <br /> PHONE ! E4- Zd y- �•S 3SFACSIMILE �z <br /> '1'ENTATIVE`APPo2amENTOATE �/;z P`'/DO TIME _ NfOrKi race f1 .1 � <br /> IPlease glue 7 t010hlI$iftSS den from date W appllcatla submittal) �i< r N �.•.n <br /> o <br /> s C:) <br /> CHECK BOX TO EXPEDITE REQUEST-$73.00 FEE—REOUEST PROCESSED IN 3 BUSINESS DAYS cri finl <br /> SIGNATURE OF APPLICANT • DA 7 f l <br /> FILE ADDRESS THIS SIDE EHD AFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH � <br /> 7 5r S L•2ZJ •JZ Ole' <br /> 3 5e5f w T 5 22 22 22 owg <br /> Zlc bc>� <br /> S r tN sSZN <br /> u ya90t Lrf 2 �Z� ^ <br /> A / Alned(Z Mw w ej 234s1 Z V <br /> D ° <br /> If n nn 000 00 <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ lI_LIv 'I�"�A1`—r�,fA- <br /> Ir UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLD WASTE FAGLrIY <br /> QTHFROLEANup SITE(Nom.Lop) 13 FOOD 3/ <br /> 0)z Lel UNDERGROUND TANK(MON 7DRING/REMOVAL) O DOG KERNELTM O DAJRY <br /> WASTE VEHICLE <br /> O HAZARDOUS WASTE GENERATOR d CHKXEN RANCH O PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY U MOTEUHOTEL U PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING ❑ POOUSPA U LANE)USE APPLICATION SnE$ <br /> O MEDICAL WASTE FACe.1TY D PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY A0OVE) <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. Fax1o_(209146"138 or mail to the <br /> address indicafed above. <br /> 2. EHD will notify the applicant if any EHO 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 fi le 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 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 EMD staff. <br /> 6. Appl ications received after 3.00 pm will be processed the next buslness day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Dr u I. azTuoo <br /> TnTot P M <br /> TOTAL P.02 <br />