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&F►cU1.r NOR Environmental PHONE NO. : 209 369 4228 Jul-l. 11 2003 11:05AN P2 <br /> 1 SAN Ji7nQUIN COUNTYPUBLIC HEALTH aE RVICES kHD1,c1cNUt+B <br /> FA <br /> ENVIRONMENTAL HEALTH DIVISI0N <br /> JUN 1 12003 304 EAST WEBER AVENUE,THIRD 1=1_00R <br /> STOI:KTON CA 95202 <br /> I'JV1R0f\.'FEINT HEALTH (x!09)468-3420 <br /> °FRN11T/'SERV1 E..(, PUBLIC RECORD.) RELEASE APPLIC,ATIO14 <br /> APPLICANT ;ja2j BUSIINf:SSIAGENCY <br /> ADDRESS <br /> PHONE ?-D5) o-7- ]D� FACSAAfLE7 .0 <br /> e f <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> I L��-f CEJ �j— TIME •/J,')-,a <br /> (Please give 7 to 10 businei s pays from data of application:3ubmitt iJ)� <br /> CHECK BOX TO EXPEDITE REQUEST. <br /> ,$a9.t10 FEE:- QIIES_T PROCESSED IN 3 Bl1$INE3S DAY,: Vil <br /> I �3 <br /> SIGNATURE OF APPLICANT _- 11 <br /> DA1.1» <br /> FILE ADDRESS —� TH13 SIDE E AHD aTAFF USE ONLY <br /> PROORANt 151.>"MGNT::SEARCH <br /> p2. <br /> bac <br /> v Son L.1a v'7r� N <br /> L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOt)SING ABATEMENT C1 SOL11: WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACIUTY 11 'noul: WASTE VI°HICLI_ <br /> UNDERGROUND TANK(MON ITORING/REMOVAL) ❑ DOC;KENNEL C1 t;AtR1' <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHl:KEN RANCH C1 F'KG r PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MO`EUHOTEL 1:1 rumv r_R TRu(1,KiYARc1CHE1%1 TOILETS <br /> ❑ TATTOO/BODY PEIRCING 0 POOUSPA 171 LAND 4}S17 APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUF LIC WATER SYSTEM Cl OTHE R(PLEASE SPECIFY ABOVI_) <br /> 1. List up to ten addresses in the space abo),e. Select the type(s) of files fro-.n the list above by chocking <br /> the appropriate box(es). At least one file type MUST by selected. Fax to :?09 464-3138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EFID files exist. An appointment.for reg riew will be confirmed <br /> approximately five: business days but no later than ten (10) days after recfapt of applicat,iorl, Thi!files <br /> will be held for a maximum of five businez s days for review. Appointinew s should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by FHD staff may not be immediately available for review. A new <br /> application may be submitted when the fit a is available, <br /> 4. Any file not returned in the same condition as released will be reor<latlized by E HD staff at the expense <br /> of the applicant. Future file reviews by th1!same applicant may requif•e a .1;89.00 deposil:prior to reviow. <br /> 5. *TENTATIVE appointment dates must be c:onffrmed with EHD staff. <br /> G- Applications received after 3:00 pm will bel processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. � TIME <br /> DATE CONFIRMED PHONE FAX INrI"1111-S <br /> REVIEWED_ YES _ NO REVIEW DATE <br />