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04/30/2003 09:42 FAX 209 9480621 <br /> �D Q-1002;00;1 <br /> OATS RI;C))I i ',. rL: 11�/ 1=� _�. \— �,1 EHD UN's NUMBER <br /> � AN JQAt�UIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 3 0 2003 304 EAST WEBER AVENUE.THIRD FLOOR <br /> STOCICTON CA 95202 <br /> _NVI't;;_i�;1l i'J1 NtAL (209)468-3420 <br /> `L'2':4!=F.\0G bI3LIC124 <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT_ / h �� �ra• �c.GT BUSINESSIAGENCY I—C 4'0-- C%1 <br /> ADDRESS <br /> PHONE FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE :!�;/i/� 3 TIME <br /> Please <br /> ( give 7 to 10 business days from date ofapplication L•uAmit[alj <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> _ IRATE _ cy <br /> FILE ADDRESS THIS SIDt:EHD S5 AFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> /8761„tivC . i <br /> 93'4 C6t�..f r C/v6 - <br /> v�l Ovntr. Ic.S I v� <br /> l J } r CrGg T5 <br /> Cl r.l t✓ <br /> /S/D 3 ovn i-r Club �!✓d, — <br /> ?.S7 S COVni-r • C/u6 ! !vL <br /> 3l V� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ..01UNDERGROUND TANK(UST)CL-E.A.NUP SITE(LOP) ❑ HOUSING ABATEMUP SITE(NON-Lop) ENT C�] ILII)WA;TL'-FACILITY <br /> -O-TNDERGROUND TANK(MONMORING/REMOVAL) O 13OGDKENNEL D <br /> FACILITYn SCILID WA4TE VEHICLE <br /> 17 HAZARDOUS WASTE GENERATOR ❑ CMICI�N RANCH ❑ DAIRY <br /> C3 TIERED PERMITTED FACILITY C3 CMICKEMOTELRANOTEL 0 PKG TREATMENT PLANT <br /> 0 TATTOO/BODY PEIRCING PIIMF ER TRUCK/YARO/CHEM TOILET:3 <br /> ❑ MEDICAL WASTE FACILITY Ll POOLISPA ••• ❑ U.N11 USE APPLICATION SITES <br /> O PUBLIC WATER SYSTEM Q O'rHt:R(PL.EA$E SPECIFY i%ROVE) <br /> 1. List up to ten addresses in the space above. Seloct the type(s) of files fram the list above by checking <br /> the appropriate box(es)- At least one file <br /> address indicated above.. type MUST be selected. Fax t:o(zos) 464-0938 or mail to the <br /> 2• EHD will notify the applicant if any EHD files exist. An appointment for revieaa will be confirmed <br /> approximately five brlsiness days but no later than ten(10)days after receipt of application. The file:; <br /> will be held for a maximum of five business days for review. Appaintrrlerlts should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediat(qy available for reiriew. Anew <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 requirrt 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 aPPO)NTMENr DATE TIME------------ <br /> ^ <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS _ <br /> REVIEWED YES NO <br /> REVIEW DATE <br />