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SAN JOAC' •'N COUNTYPUBLIC HEALTH SEF CES EN*o RONMENTAL HEALTH DIVISION~ D 304 CAST WEBER AVENUE-,THIRD FLOOR •/ +/ STOCICTON CA 85202 a — 0 / (209) 468-3420 PUBLIC RECORDS RELEASE APPLICATION APPLICANT GlgSL--j KIaF /Ql e- ASSou OUSINESSIAGENCY ADDRESS I i J 7 Lb,01'- PA"m Aug, tri. J�3� NbD�sro. PHONE �n9) •579-LaLI FACSIMILE C?s�9) 579 — 22-2-5�5 orT 0 4 2002 y TENTATIVE'APPOINTMENT DATE" TIME FNVIRONM NT HEALTH (Plca.o Blvc 7 to,o; �;n Iro, ale 1��'lo u"IR I) PERMIT/SERVICES 11 CHECK BOX TO•EXAE ITE REQUEST-$07.00 FCE-RCQ II ST PROC SSE USI SS DAYS SIGNATURE OF APPLICANT DATE 9P )0 -011-OL FILE ADDRESS THIS SIDE EHD STAFF USE ONLY PROGRAM ELEMENTS SEARCH T L- � L - A7bC.10*6 U 1 ELw6r 9&stb&^An4 - 14 - ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK(MONITORINGIREMOVAL) Cl DOG KENNEL ❑ DAIRY 13 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCI4 ❑ PKG TRUCNT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPEERR TRUCI(/YARDICHC-M TOILETS ❑ TATTOOIBODY P14IRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTL FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be Selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $37.00 deposit prior to review. 5. •TC-NTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED- YES NO REVIEW DATE [H iY 14 aaa"oa - - .