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it <br /> SAI3AQI`]11�1 CakJITYPUBLIC HL'ALTH -RViCES <br /> ENVIRONMENTAL HEALTH IDMS 1 � <br /> 3174 EAST WEBER AVENUE,THIRD FLOOR <br /> l0 Z001 1 STOCKYO CA 95202. <br /> v <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ._JJ.: <br /> APPLICANT `{i P O.-d` (/e; BUSINEssimizxCY, <br /> ADDRESS �ryi/ y <br /> PHONE gLiR ( FACSIMILE. `-T lei ` - - <br />' Ak <br /> TENTATIVE"APPOINTMENT BATE TIME�� � I --- <br /> (Piazze!give 7 to 10 business days from date of apPiieatiai submittal) <br /> v( IV �I <br /> CHECK BOX TO EXPEDITE RE=QUEST-$87.0�FER UFST PROCF.SSE 1Pi 3 DUStN DAYS` A,SIGNATUI�tk OF APPLICANT . DATE <br /> l <br /> r. <br /> FILEADDRESS i MIS SIDE END STAFF USE ONLY <br /> doh <br /> 'iPROGIRAN E.EMtNT5 SEARCH <br /> � k •�c rte.. � ... ca ,� e35 a _ <br /> � If <br /> I <br /> �I <br /> �l <br /> 'lE <br /> ENVIRONMENTAL HEALTH DIVISION)FILES <br /> UNDERGROUNO TANK(UST)CLEANUP SITE(LOP) d HOUSING ARATEMENT ❑ SOLID WASTE FACILITY <br /> EJ OTHER CLEANUP SITE INOWI,OP) ❑ FOOD FACILRY l a SOLID WASTE VE=HICLE <br /> UNDERGROUND YANK(MONITOERINGJREMOVAL) EO DOG KENNEL ± n VAIRY <br /> O HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PqRMnTTED FACILITY 17 MOTEUHOTEL 1' PUMPER TRUCKfYANL1I0NEM TOILETS <br /> D TATTOOMODY PE^IRCING ❑ POOLlSPA I 0 LAND USE APPLICATION SIYE,S <br /> 0 MEDICALASTE FACILrrY D PUBLICWATERSYSTEM 13 OTHER(PLEASE SPECIFY ABOVE) <br /> of files from the list above by Chockings i <br /> I. List up to ten addresses in the space above. Select the typ e{ },� <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(20914 64-0.13.8 or mail to the <br /> address,indicated above. I <br /> 2_ EMD will notify the applicant if any EHD files aXiSL An appointment for review will be confirmed <br /> approximately five business days but no later than ten(i0}days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should he scheduled <br /> accordingly. ! f <br /> 3. A rile that is actively being worked on by END staff may not be Immediately available for review. A new <br /> appiication may be submitted when the file is avallable. <br /> 4_ Any file not returned in the same condition as released vW1 be!reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5_ *TENTATIVE appointment dates must be confirmed withJEHD staff. 1 <br /> 6. Applications received after 3:00 pm will be processed the next business day. } <br /> CONFIRMED APPOINTMENT DATE L7 TIME - <br /> DATE CONFIRMED PKONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EK fl0 74 W07XC <br /> Jr <br /> l J1 <br />