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DATE HEC.EIVEll <br /> stp Loc Not4ot:Q <br /> ?i SAN QjkUIN COUNTYPUBLIC HEALTH :,VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> AUG 2 n= Z001 F <br /> STOC g)46 95202 <br /> EPlVII�',uld;v'�EI�� "�ALiH (zas)4ea-3-3 420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Li <br /> APPUCAxx_M V. i Lk"', SUSINESSIAGENCY CO,tioLov <br /> ADDRESS 188 Fr- .n W{ G rtlQa �w +1L <br /> PHONE 2.401I - 2 3 _ oS 1 t3 FACSIMILE 20'1- 2-S-4 _ o s t 8 • <br /> T1-NTATTVE"APPOINTmENTDATE & 3a/�Loa I TIME B . S o <br /> 117 <br /> (Please give give 7 to 10 b/u`s/ess days from date of appllcatlon submfttal} <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE—REQUEST PR CESS IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT rDATE <br /> FRE AI)ORESS THIS SIDE FHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> a �- <br /> _* a , <br /> O � <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> H jiNDERQROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT L7 SOLID WASTE FACILITY <br /> 1�9TNF.R CLEANUPS E(NON-LOP) rl FOOD FAC0.TIY - ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITOR21GIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 12'HATJIR0003 WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TRFA.rMFNT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ SATTOWBODY PEiRCING ❑ POOLISPA -- ❑ LAND USE APPLICATION SRF$ <br /> IV MEDICAL WASTE FACH.ITY Cl 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 to (209) 464-0138 or mall to the <br /> addrass Indicated above. <br /> 2. END will notify the applicant if any END 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 EHO 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 END 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 /> 5. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />