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04/30/2003 09:42 FAX 209 9480621 <br /> 1�1 004.'00;1 <br /> DATE RECEry EhID U NUMBER <br /> AN JO�MUIN COUNTYPUBLIC HEALTH SEFZvICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR :3 0 2003 304 LAST WEBER AVENUE, THIRD FLOOR <br /> STOCICTON CA 95202 <br /> (\!V!F.�I;!1r1EiJl HEAL (209) 468-3420 <br /> _ �,..��-;�F�:>,�t WUBI_IC RECORDS RELEASE APPLICATION <br /> APPLICANT �/P /"/i�� .G�� BUSINE=AGENCY <br /> ADDRESS x-82$- �.� /'�Jyr,I-(-e <br /> PHONE q1711k— /3 yS —FACSIMILE_ <br /> TENTATIVE'APPOINTMENT DATE / � y 3 TIME <br /> (Please give T to 10 business day:from date of application t;ubmiit_alj <br /> CHECK BOX YO EXPEDITE REQUEST-$87.00 FEE—REQUEST PROCESSED IN 3 BUSINEGS PAYS <br /> SIGNATURE OF APPLICANT w � '/ iv - Lul <br /> OATE <br /> FILE ADDRESS THIS SIM c EI1D Si'AFF USE ONLY <br /> PROGRAM t7LEFIENIS SEARCH <br /> J9 Y4 <br /> 876 T-Ov.-+-F� C(vb bl✓�. . i � --- - <br /> kilt <br /> �C� 1 O�ntr• It+� 1 ✓Z <br /> nw� l0 3 T r G(ob Ts'(v� I <br /> �/� � S ( COV.,-fir Cl�,l ��✓ <br /> ^i <br /> /5/03 oc�n+-r Climb i3!✓Z — - - <br /> --- <br /> COUAfn Climb I !vL <br /> -70,;' v.. CIu6 1?,f v� — - <br /> `o�.7v� S C 131L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> -O'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 'C7 ,Sf'Lit.)WA:;TE FACILITY <br /> ,.•^OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SCILIL)WASTE VEHICLE <br /> - 'GNDERGROUNO TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DIORY <br /> 0 HAZARDOUS WASTE GENERATOR. ❑ CHICKEN RANCH ❑ PH:G'rREArMENT PLANT <br /> C TIERED PERMITTED FACILITY CJ MOTEUHOTEL0 PUMPER TRUCWYARDICHEM TOILET:i <br /> CJTATTOOIBODY PEIRCING ❑ POOtjSPA •• ❑ 'U,NCI USE APPI-ICATION SITBs <br /> ❑ MEDICAL WASTE FACILITY EDPUBLIC WATER SYSTEM ❑ 07HCR(PLEA:5E SPECIFY ABOVE) <br /> 1.. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es)- At least one file typo MUST be selected. Fax 1.4+203) 46d-0738 or mail�a tl-ie <br /> address indicated 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 rt)Cteipt of application_ The fill::; <br /> will be held for a maximum Of five business days for review, Appointments!;�OLIId 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 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 require a $87.00 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 busine:;s day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL.!; _ <br /> REVIEWED YI±S NO REVIEW DATE: <br />