Laserfiche WebLink
SAN JC "RUIN COUNTYPUBLIC HEAL IF H SF tcc5 <br />- �"VIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE. THIRD FLOOR Z <br />FEB 2 0 2001 STOCK70NCAS5202 J <br />(209)468-3420 <br />H!''IRi aPd; i1i Hc.ALTH PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT Q,&-\,) i of Lee- BUSINESSIAGENCY <br />Dut- <br />u�F <br />&III, ��J��0& rift <br />I•,,,,,,..atLE c� <br />rthLUS� 2-27 C� /}%� j1;3ok•M• <br />TENTATIVE' APPOINTMENT DATE __-__ t n 1, T1ME 1 • <br />(Please give 7 to 10 business days from date of appllptlon submittal) <br />77��pp(T •$-1 <br />K -ti BUSINESS PAYS <br />CHECK BOXTO EXPEDITE REQUEST - i7dOEE RE OCESSED IN <br />O <br />SIGNATURE OF APPLICANT DATE OZ -11r, <br />UNDERGROUND TANK (USTI CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />0 HOUSING ABATEMENT <br />❑ FOOD FACILITY <br />❑ SOLID WASTE FA¢jt�. jI�(�%11II'I I <br />❑ SOLID WASTE VEltytfltl�l(v:C�-nnJ'�-'�)�k1T�t1 �I(�f yI „' `Il((ufffJ lL�� <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />. _ r_. t , <br />ITIX�t�lffllr/Iilly/. L11�'. <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKfYARDICHEN TOILETS <br />❑ TATTOO(BODY PEIRCING <br />- ... �. .... <br />❑ LAND USE APPLICATION SIR <br />21 <br />.. ... <br />IRMO[rrT���I <br />ID OTHER (PLEASE SPECIFY ABOVE) - - <br />UNDERGROUND TANK (USTI CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />0 HOUSING ABATEMENT <br />❑ FOOD FACILITY <br />❑ SOLID WASTE FA¢jt�. jI�(�%11II'I I <br />❑ SOLID WASTE VEltytfltl�l(v:C�-nnJ'�-'�)�k1T�t1 �I(�f yI „' `Il((ufffJ lL�� <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY IJtJUu <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKfYARDICHEN TOILETS <br />❑ TATTOO(BODY PEIRCING <br />❑ POOLISPA <br />❑ LAND USE APPLICATION SIR <br />21 <br />❑ MEDICAL WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM <br />ID OTHER (PLEASE SPECIFY ABOVE) - - <br />1. List. up to ten addresses in the space above. Select the type($) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (200) 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 len (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 Tile 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 />EH N 14 GwS <br />