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02/01/2002 16:04 2094671118 AGS. STOCKI UN i ''u` U <br /> EHD LOG NUMBER <br /> SAN JSQUIN COU TYPUBLIC HEALTH -AVICES <br /> 1 ENVIRONM NTAL HEALTH DIVISION <br /> 749S 304 EAST WE ER AVENUE,THIRD FLOOR <br /> �' 1 ST CKTON CA 95202 7 <br /> 209) 468-3420 4F <br /> PUBLIC RECOR S RELEASE APPLICATION <br /> APPLICANTU?_a I'l, �kAQNSI ESWAGENCY I <br /> ADDRESS 9 3 9 L'�Aqo <br /> PHONE ad �g) yiDa6 FACS MILE <br /> TENTATIVE*APPOINTMENT DATE D TIME <br /> (Pleas give 77tto 10 bu " ss da s from to of application submittal) <br /> CHECK BOX TO EXPEDITE REQ U - S10 EE- E 5 D IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FI E ADDRESS <br /> 11100 <br /> F p a -� <br /> . dD <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> FEB -6 2002 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d HO SING ABATEMENT Q SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FO D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) CJ DO KENNEL In DAIRY <br /> HAZARDOUS WASTE GENERATOR Q CHI KEN RANCH a PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MO EL/HOTEL. ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ PO L/SPA C3 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ pU LIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space abo e. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file ype MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicates(above. <br /> 2. END will notify the applicant if any EHD fil s exist. An appointment for review will be confirmed <br /> approximately five business days but no I ter than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five busine s days for review. Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by HD staff may not be immediately available for review, A new <br /> application may be submitted when the fil is available. <br /> 4, Any file not returned In the same conditio as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be onfirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01/05/00 <br />