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°FRuiI � A Environmental PHONE N0. : 209 369 4228 u-1. 11. 2003 11:05AN P2 <br /> I� SAN JUIN COUNTYPUBLIC HEALTH :��VICF..S c"gSDcNUMBER <br /> ENVIRONMENTAL HEALTH DIVISI!�N <br /> v JUN 1 1 2003 304 EAST Wt BLRAVENUE,THIRD 1=L0(7R <br /> STOI;KTON CA 95.202 l <br /> =NVIRGI'gNIEiNT HEALT)-) ((09)468.3420 <br /> PERr�ir sE ver` P'U'BLIC RECORDS RELEASE APPLI CATN <br /> IO <br /> APPLICANT 1�i Cj ULV C BUSIN;.$$fAGENCY /64 /��'��• /� / <br /> ADDRESS <br /> PHONE IE�F X-7-3 7b <br /> ..—_—FAC5R71LE(TS14�,3ceg- T<:,�r6 <br /> TENTATIVE*APPOINTMENT DATE IPII4+J03 TIME <br /> (Please give 7 to 10 busine=a ays�om date of appl(ratlon suiimitt ilj—� - <br /> CHECK BOX TO EXPEDITE REQUEST�EE- QI ZEST PROCESSED IN 3 8(J$iNEa5 DA)'., 1�3 . <br /> SIGNATURE OF APPLICANT ��� <br /> -- DATE � �o I�t lU <br /> FILE ApORESS THi:I SIDE F l STAFF USE ONLY ... <br /> PR OG RANI ELEMENT::SEARCH ( 1 <br /> erlo Pry 93(o Sdnc �vrt �— \/ <br /> d Son GJw <br /> V ( o >^ IJQ <br /> ENVIRONMENTd1L HEALTH DIVISION FILES <br /> tat UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOtISING ABATEMENT Cl SOCK WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOCID FACILITY Cl SOLK WASTE VI-HICLJ- <br /> of UNDERGROUNn TANK(MONITORING/REMOVAL) ❑ DCY;KENNEL Cl DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHII:KEN RANCH CJ PKG rp.mvrINFItr PLANT <br /> ❑ TIERED PERMnYED FACILITY ❑ MO'ELIHOTEL [7 YUMi�1=R'I'I�l1CKNARCICHEM17 TOILETS <br /> ❑ MEDICALTATTOOIAS PEIRCILI ❑ POOLISPA 11 LANO US13 APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑ PUB LIC WATER SYSTEM r1 OTHIn(PLEASE SPECIFY A60V13) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files fro m the list above by checking <br /> theappropriate box(es). At least one file Type MUST be selected.-Fax to :}09 464-0138 or mail to the <br /> address indicated above. –f'— — <br /> 2. EHD will notify the applicant if any EFID files exist. An appointment for re�r)ew will be confirmed <br /> approximately five business days but no later than ten (10) days after recolpt of application. The files <br /> will be held for a maximum of five businer S days for review. Appoirnbnents should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediatel V available for review. 'A new <br /> application may be submitted when the fit Is available. <br /> 4. Any file not returned in the same condition as released will be morgaliizo(I by EHD staff at the expense <br /> of the applicant. Future file reviews by tln.same applicant may require a 589.00 deposil:prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b(i processed the next business day. <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INrnim-s <br /> REVIEWED_ YES _ NO REVIEW DATE ' <br />