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DATE REGENED L140 LOi:NTJWflR <br /> SAN ,S AQUIN COUNTYPUBLIC HEALTH :,.,�•�tVICES <br /> S ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKCON CA 95.202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ApPUCAN �+ ,8US1NES3lAGENCY�QJL>p� 1�/ � e �r� <br /> AADRESS S / ryry `) (� <br /> PHONE & y��-/ -1666.- _ FACSIMILE �Q !rjllfd <br /> TENTATIVE*APPOINTMENT DAlt 71ME /�•f it r_' <br /> (Please give 7 to 10 bualnaz&days f0m date of applirAtton zubtWttai) <br /> GHcCEC BOX TO EXPEDITE REGIU 78.00 FEE--REQ PRO ESSE iAE 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t 0 <br /> / FIIX ADDRESS <br /> 117 S 1c C d <br /> 61 f F- 467 <br /> �.. <br /> /KWv uAl <br /> In k . r a <br /> AVLAS . jtj <br /> VIA <br /> S s3 <br /> � rI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> OTE[ER CLEANUP 517E(NON-LOP) R FOOD FACILITY C1 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER f RUCIVYARQlCHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING C1 POOL/3PA ❑ LAND USE APPLICATION$ITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTE=M ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the spate abovo. Select the type(s)of files from the list above by checking <br /> the appropriate bax(es). At least one file type MUST be selected. FaX to(209)464-0138 or mail tQ Elie <br /> address irWi ted above. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review 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 review. Appointrnenfs should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <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 rat(uire a $78.00 deposit prior to review, <br /> 5. '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 CONFI"ED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 04 14 ViM900 �^ <br />