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il-lq-tiou�u �-for r� r I I%_V <br /> KULMIvr" sAN JoO kQUIN COUNTYPUBLIC HEALTH S'ERVIC <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR N <br /> STOCkCrOA 95202 <br /> V6, <br /> (209)466-3420 <br /> PUBLIC RECORDS RELEASE APDL ICATt010 ERM'ISE <br /> APPLICANT ' L BUSIKESSIAGENCY Q ` �SS� <br /> 0 ,f-� V <br /> ADDRESS O <br /> PHONE FACSIMILE �-- <br /> TENTATIVE*APP01kTNftNTPATE tom" 211 — 00 TIME <br /> (Please give 7 to IU business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE_REQUEST' .uQ FEE- 4UEEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> IEE ADDRESS 1513 SIDE EHD STAFF USE ONLY <br /> PfiQGRAM£LEMr.NTS,SEARCH <br /> L -- 3Sag' n� L <br /> � <br /> Q0 o c.`f <br /> AY <br /> ENVIRONMENTAL HEALTH-DIVISION FILES <br /> D HOUSING ABATEMENT ❑ SOUO WASTE FACiLI'TY <br /> )?_Q UNDERGROUND TANK(UST)CCEARUP SUE(LOP) ❑ FOOD FACILITY D SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) KENYEL E3DAIRY <br /> UNDERGROUND TANK(NIQNrroRiKGMEMOVAL) ❑❑ DOG DOGCHIKL'N RANCH PKG TREATMENT PLANT <br /> KAZARAQUSWASTE GENERATOR ❑ MoIEL(HOTEL CI PUMFERTRUCKIYARWCHE!UTOILETS <br /> TIEREfiO T+ERm1TTED F=ACILITY ❑ P60LJSP4 ❑ LAND USE APPLICATION WES <br /> 0 TATTOWBODY PORCING puaUC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL y1rASTE FAe1L.tTY <br /> 1, List up to ten addrisses in the space above. Select the type(s)of files from the list above by checking <br /> the'dpproprlatO boX(es). At least one file type MUST be selected- Fax to(24914134:q or traN o the <br /> address Indicated al, ot[e <br /> 2- EHD will notify the 91pplicant if any EHD files exist. An appointment for review will mconfirmed <br /> he flles <br /> approximately five business days but no later than ten(10)days after receipt of application. <br /> will be held for a maximum of five business days for review. Appointments should be schedu]ed <br /> accordingly. <br /> 3, A file that is actively being worked on by ERD staff may not be ImmadiatelY available for review. Anew_ <br /> application may be submitted when the the is availablo. <br /> 4. Any file not returned in,the same condition as released cant may reorganized ufre a S 7. E D staff <br /> as prior expense <br /> of theapplicant. Fu urQ file reviews by the same app Y re4 <br /> 5- ~TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications receiveci after 3:Oa pm will be processed the next business day. <br /> ER _ <br /> APl?O)NTMENT DATE TIME <br /> MED PHONE FAX INITIALS <br /> YES <br /> NO RI=VIEW DATE <br /> TOTAL P-01 <br /> 7nnrD) j�ng o�r.TTaiI 5906 ZLS 9T6 %63 59=5T 00/6T/TT <br />