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a 111nnA IPJgoY/002 <br /> 07/22/1Uu4ti40138 ENVIRONMENTAL I-EALTH PAGE 01 <br /> �N J( IUIN COUNTYPUBLIC HEALTH S,_ VICES <br /> ENVIRONMENTAL HEALTH DIVISION IW9 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> (220KTON CA 2 09)468.3420 , <br /> ` �i'USLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Al LI' vv� BUSINE99lAGENCY W 2.S�n �j ✓IS ^ ,1Lc . <br /> II <br /> AnDREss Ira---15 Trt o J- `31yd I Wa1hO�- C,Vy_e_L} C- �yggS <br /> PHONE -1 ZS FACSIMILE_ R 2 S ^'J S ^l D4 b s <br /> TENTATIVE*APPOINTMENT DATE -71-30102- TIME !O: Oa 4 , _ <br /> (Please IVs 7 to 10 business dais ofa <br /> a Bc2,M,MNES,ub,mA1YaI) <br /> Lem,rs TQ�PCHECK BOX TO EXPEDITEREQUEST-E09.00 FEE—REQUE�/ dS 11K9 . <br /> SIGNATURE OF APPLICANT DATE <br /> PILL ADDRESS THIS SIDE EHD STAFF USI? 3 Y' 2002 <br /> PROGRAM ELEMENTS SF cH. <br /> 301p Snu11 + 5� X 5 Sacc Z n <br /> R 1 W . �.wilovL�- 8}- ra Ice c.1c. n <br /> rtk � S1-pc�.-��✓T <br /> vy ?31-2-?aS. rnTw ' <br /> n`a <br /> W. rr�on��ti�?3-pd�kOn /� <br /> I m (� <br /> ENVIRONMENTAL HEALTH DIVISION FILES 'I �/ <br /> ,ry UNDERGROUND TANK(U91J CLEANUP SRE(LOP) ❑ HOUSING ABATEMENT A SOLID WASTE FACILRY�A. <br /> �9 OTHER CLEANUP SITE(NOIR-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHtCLFi'4" <br /> �I UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL O DAIRY - <br /> 2�Q( HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PL's <br /> TIERED PERMITTED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRUCKIYAI4J*AEM TOILETS <br /> ❑ TATT0018O0Y PEIRCING ❑ POOVSPA ❑ LAND USE APPLICATU Su E9 <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SVECItY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboie.by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)4G4-0138-4 mail to the <br /> address Indicated above. 4 <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be 6d9lmed <br /> approximately five business days but no lator than ten (10) days after receipt of appllcaNn. The files <br /> will he held for a maximum of five business days for review. Appointments should be 9.4heduled <br /> f. <br /> accordingly. <br /> 3. A file that Is acl'.Evely being worked on by EHD staff may not be immediately available fof`Taview. A new _ <br /> application mail be submitted.when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD slaflet the expense <br /> of the applicanrt. Future file reviews by the same applicant may require a$89.00 depogiT'prior to review. <br /> 5. 'TENTATIVE appointment dates must be conflrtned with EHD staff. <br /> G• Applications received after 3:00 pm will be processed the next business day. <br /> t <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMFD PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />