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07 / 08 / 2002 HON 12 , 50 FAX 916 5654356 Z001 / 001 <br /> LSH ENVIRONMENT =ACTH PAGE 91 <br /> N " sAN JOAQUIN GOI INTYPUBLIC HEALTH SERVICES ' Looe <br /> Jr � e ■ ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> ST (209) 4N C3420 z <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICA710N <br /> AP_CLICANT_( i422L_—, �-�J_Il <br /> ii n ' �f=•T-�;a.� 13USMESSIAGENCY <br /> PHONE �- <br /> PHONE n9(! - �� ••-' <br /> fr1`r�. PACSIMILE <br /> . TENTATIVE` APPOINTMCNT DATE <br /> TMC <br /> C� (Pltasa glue -r t 1 d apple aebmlttal) <br /> CHICK DO% TO EXPEDITE REQUEST - •00F s <br /> — � ST OCE IN ] INESS DAYS <br /> SIGN##IRE OF APPLICANT - <br /> O DATE oL _ <br /> FTI$ gppRESS <br /> THIS SIDE Eryp STAFF USE ONLY <br /> PROGRAM�£LE6tENT5 SEAROH <br /> Sz <br /> GeZ41 y. <br /> w1 eI;� 9 <br /> Z <br /> � . <br /> -dl. .J 5• 5 , <br /> 2� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> (4 UNDERGROUND TANK (U" CLEANUP SITE (LOP) o HOUSING ABATEMENT 0 SOLID WASTE FACILrry <br /> D OTHER CLEANUP SITE (NON{Op) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> D UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IA HAZARDOUS WASTE GENERATOR d CHICKEN RANCH . 13 PKG TREATMENT PLANT <br /> 0 <br /> TIERED P ODYp EtRCING ,1'rY ❑ MOTELIHOTEL ❑ PUMPERTRUCKIYARO/CHEMTDTLETS <br /> CI D MEDICAL <br /> WAST EIRCINO ❑ -POODSPA Cl LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACIIr[Y ❑ PUBLIC WATCR SYSTEM o OTHER (PLEASE SPECIFY ABOVE) <br /> 14 List up to ten addresses in the space above- Select the type(s) of files from the list above by checking <br /> the appropriate bo%(es), At least One file type MUST be selected. Fax-to 209 464-0198 or mail to the <br /> address indicated above <br /> 20 LHD Will notify the applicant if any EHD flies exist, An appointment for raview Will be confirmed <br /> apprOXIMately five business days but no later than ten (10) days after receipt of application. The files <br /> Will be held for a maximum Of five business days for raview. Appointments should be scheduled <br /> accordingly. <br /> 3. A file 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 avall3blo, - <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 X$89,00 deposit prior to review, <br /> s. '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 /> ReVnEWEP _ YES - NO � . RLInEyItD.ATF ., .._ <br /> Post eFax Note 7671 DRte7 rL aipol°s�' <br /> Ta From <br /> Co10epL °- �•-Gd � � <br /> Ph« k Piwno aLG^l co 5' - Zd <br />