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08-21-2eCO 02:L4FM ---'P1 TO 66'l.38Fi9 P.01 <br /> S,^*wJOAQU1N COUNTYPUBLIC HEALTH SrRVICES . <br /> Cl ENVIRONMENTAL HEALTH DIVISION rA `. <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> AUG 2 5 2000 STOCPJ NI CA 95202 <br /> (209)466.4420 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PE APPU AJ9 5=f63q eUSINESSlAGENCY <br /> -ADDRSGS elf.71eI 0F! ea��.L_��C- 5-rs x- w Sao- 9 <br /> PHONE aC� ' Lf(� 7 '�a�� 9r� O �,/ f . <br /> �Q ��FACSIMILE Ord [ -' / � S <br /> A'C'�fe7- 5 339 •/lr <br /> TENTATSYE•APParmr: <br /> rNT DATE S E,v.�, (e,a �o HILI, oo ,4."' CO-C C' <br /> I-� (Please Give 7 to 10 buair a days from dote of application GubMktal) vL.( L, f.}-/I,1 ry^��n—�/� <br /> CHECKBOXTOEXPEDrMRETilr65T,W.00 FEE-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT irzu r_.. Z - DATE g t_ Com.n U-0- <br /> LX Vu <br /> , /)LXVu tm <br /> F, F E ADD S THIS EAE END STAFF USE ONLY <br /> nix-, PROGRAM ELEMENTS SEARCH n0 <br /> n.JT <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> .V UNDERGROUND TANK(UST)CL.EILYUPSITE XOP) O HOu51NGARATEMEW Q SOLD WASTE FACILITY <br /> Rr OTHER CLEANUP M`M(NON-LOP) O FOOD FACILITY Jr SOLID WASTE VEHICLE <br /> ar UNDERGROUND TANK(MONITORINGntEMOVAL) O DDG KENNEL. ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13 PKO TREATMENT PLANT <br /> TIERED PERMITTED FACILITY CO MOTELMOIEL 11 PUMPFRlRUQK/YARp/CNEMTo&ETS <br /> O TATTOO/800YPo)RCWG ❑ POOLJSPA C LANG VaEAPPLICAT1ON31TEb <br /> MEDICAL WASTE FACHJTY 2 PUBLIC WATER sYSTEm Q OTHER prLEASE SPEC(FYADOV67 <br /> 1. List up to ten addresses in the space above. Select the type(s)of tiles from the list above by checking <br /> the appropriate boMes). At least one file type MUST be celerted, Fax to 120914644138 or mtljl t rn <br /> address tndi &d above, <br /> :2. EHD will notify the applicant It any EHD filed exist An appointment for review Wll be confirmed <br /> approximately five buciness days but n0 later than ten (10)days atter receipt of app6Datfon. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> at:cordingty. <br /> 3. A rile 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 Nle is available. <br /> 4. Any file not returned in the Same COndINoR as released will be reorganized by END staff at the expense <br /> of the applicant, Future fitc reviews by the samC appliCant may require a$87.00 deposit prior to rWiew. <br /> 5. 'TENTATIVE appointment date$must be confirmed with EHD staff. <br /> 6. Applications receded after 3:00 pm will be prowssod the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> OATS CONFIRMED PHONE FAX INITIALS <br /> I kEVIEWED YES NO REVIEW DATE <br /> OP H NRlao <br /> TDTfT, P.91 <br /> TOTAL P.BS <br />