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SAN Jt `JUIN COUiIN YYUBLiC HEALTH S VIUL:4 <br /> ZCJVIRONMENYAL HEALTH DIVISIOW' <br /> 304 EAST WEBER AVENUE,THIRD FLOOR '' <br /> NAV 11 2000 s roc09)468 3420 <br /> ENS NEAP- PUBLIC RECORDS RELEASE APPLICATION <br /> EN9t��L nNTC ��tA) I e BUSINESSIAGENCY Qd0,2ACieLY l}Pot�'iu�hDh/}?L°� <br /> ADDRESS `y-7 �7� .•f 1W,�L11160 Q L.' lA 5;ROXS— <br /> PHONE o(O7 7_LD !–�U(7✓Y! FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE of _G^ TIME pk "0O <br /> (Pla=e give 7 to 10 business days from date of application submittal) it <br /> r-y LU <br /> u .CHECK BOX TO EXPEDITE REQUEST•$7a EE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE too- <br /> FILE <br /> oo-FILE ADDRESS <br /> C"X, Sz-j <br /> \I afrin81 <br /> \"l O-N v <br /> �c n� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY O <br /> OTHER CLEANUP SITE(NDN-LOP) 13 FOOD FACILITY SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITOKINGIREMOVAL) q DOG KENNEL ❑ DAIRY O <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIROTEL ❑ PUMPER TRUCKP/ARO/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING Q POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in-the space above. Select the typo(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 mail to the <br /> address indicated 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 LN <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 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 EHD 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 /> REVIEWED YES NO REVIEW DATE <br />