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12/07/2001 11:42 90127` 16 OFFIC;EhAAX 4 06n— PAGE 01 <br /> \ -1 .111,OATE HECENED EMO LM NLIMBFFt , <br /> V SAN —wAQUIN COUNTYPUBLIC HEALTH RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> r, 304 EAST WEBER AVENUE,THIRD FLOOR <br /> I STOCKfON CA 95202 <br /> (209) 468-3420 • <br /> _ PUBLIC RECORDS RELEASAEnAPPLIC`A.TIO <br /> ffe <br /> APPLICANT yy\(DaCQTc BUSINESSfAGENCY <br /> ADDRESS <br /> PHONE cD >) Q-_')— 7 FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE SJI:J`Z- TIME <br /> (Please give 7 to 10 business days from date of applicatlon submittal) <br /> Uli/7 -) 3El � <br /> CHECK BOX TO EXPEDITE REQUEST-578.00 FEE—REQUEST P OC SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> ---, O <br /> J/ _ _oP� PET�2s 1�n C.o mpAN`� - --� <br /> 3 N�y� Ota+.y� g-�c�c�Csoe�1EUN LLD <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �jUNDFRGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOL113 WASTE FACILITY <br /> 51 THER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 57 UNDERGROUND TANK(MONITORINGIREMOVAL) Q DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ 'TIERED PERMITTED FACIIJTY ❑ MOTELIHOTEL 0 PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑ TATTOOJBODY PEIRCING C1 POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 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 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 <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 /> EM W 14 01M5)DO <br />