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28/2002 13:29 20946711 AGE STOCKTUN -,"u- J'iuZ <br />01/ <br />01 / RECEIVED tHO LOG NUMBER <br />JO QUIN COU TYPUBLIC HEALTH SEMMES <br />ENVIRONME TAL HEALTH DIVISION r� �r <br />� 11 <br />304 EAST S O R AVENUE KION CA 9 202 THIRD 'rA i. LL <br />�28 etq\2 5\ ( 09)468-3420 <br />Jpt,- -i <br />2 PUBLIC RECORD RELEASE APPLICATION <br />APPLICANT �\ufa �' BUSIN SSIAGENCY �/— �• <br />ADDRESS Q <br />PH a� FACSI ILE <br />TENTATIVE' APPOINTMENT DATE TIME • <br />(Please give It 1D busine s days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST . E7 g FEE - REQ EST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE t z 8 oz <br />FI E ADDRESS <br />O <br />Dili <br />/ i , <br />L7,Q It <br />k A%r ipw <br />V <br />ENVIRONMENT L HEALTH DIVISION FILES JAN 31 2002 <br />UNDERGROUND TANK (LIST) CLEANUP SITE (LOP) D HO SING ABATEMENT SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON-LOP) ❑ FOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONRORINGlREMOVAL) ❑ Dq KENNEL d DAIRY <br />HAZARDOUS WASTE GENERATOR p CHI KEN RANCH PKG TREATMENT PLANT <br />71ERE0 PERMITTED FACILITY O MO LIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOIBODY PEIRCING O PO USPA ❑ LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY ❑ PU UG WATER SYSTEM Cl OTHER (PLEASE SPECIFY ABOVE) <br />1. <br />List up to ten addresses in the space abc <br />the appropriate box(es). At least one file <br />address indicated above. <br />2. <br />EHD will notify the applicant if any EHD f <br />approximately five business days but no <br />will be hold for a maximum of five businc <br />accordingly. <br />3. <br />A file that is actively being worked on by <br />application may lie submitted when the f <br />4. <br />Any file not returned In the Same conditi, <br />of the applicant. 176ture file reviews by t1 <br />5. <br />-TENTATIVE appointment dates must be <br />6. <br />Applications received after 3:00 pm will I <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED YES NO <br />Select the type(S) of files from the list above by checking <br />i MUST be selected. Fax to (209) 464-0138 or mail to the <br />s exist. An appointment for review will be confirmed <br />ter than ten (10) days after receipt of application. The files <br />days for review. Appointments should be scheduled <br />-1D staff may not be immediately available for review. A new <br />is available. <br />as released will be reorganized by EHD staff at the expense <br />same applicant may require a $78.00 deposit prior to review, <br />mftrmed with EHD staff. <br />processed the next business day. <br />TIME <br />PHONE FAX INITIALS <br />REVIEW DATE <br />