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vv cuvd v9:42 FAX 209 9480621 <br /> wl002,OO;t <br /> EHD VY HUMBER <br /> JOt=IN COUNTYPU6LIC HEALTH SERTCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 3 0 2003 304 EAST WEBER AVENUE, THIRD FLOOR <br /> ST (209)46 -3 90 I 1 <br /> -NVI'r;u �;MtP•JT HtAL (209)468-3420 <br /> •F� Iy/BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT � ��� /_/�•^j.�G'�, BUSINESS/AGENCY /� nG� �•1<'r-.yTT —�n� <br /> ADDRESS._ 'ate-iP� S �s� /✓Jjir.,L f� S-` -__-__ <br /> PHONE �y7S /3ys FACSIMILE 9�/P�D6 ='—/ _ _ <br /> TENTATIVE"APPOINTMENT DATE 5/ /r/� 3 TIME / Dy \ <br /> (Please give T to 10 husinesc days from date Of application L'uhmatalj <br /> CHECK 60X TO EXPEDITE REQUEST•$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS OATS <br /> UA' V, -4 <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS THIS SIO[:E41D S'i'AFE USE ONLY <br /> PROGRAM O-EI/ENTS SEARCH <br /> /876 Ca, +r C!✓s TS✓C i y - <br /> 081 0��+., I� 1 ✓C _ -- <br /> �( O 3 T•r GILy T3'!✓L 1 ..r_ - <br /> l`-103 Duni-•' GIuS �!✓Z, c j <br /> I C.O W-1-r• C�uS /✓L _ ale - -- <br /> RS75 Coun+.. . r/✓S l ITL - / -- - <br /> 70 -- <br /> o17oZ s �Ou r�-fr C!✓S 131vL a) �r,,,`� -- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> .A'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 $EIMD WA>TE FACILITY <br /> ,13'OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> -B')U-NDERGROUND TANK(MONfrORING/REMOVAL) ❑ DOG KENNEL L1 DAIRr <br /> O HAZARDOUS WASTE GENERATOR. ❑ CHICKEII RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILFTY ❑ MOTEL/HOTEL ❑ PUMF'ERTRUCYJYARDICHEM TOILETS <br /> ❑ TATTOO/DODY PEIRCING ❑ POOLISPA ❑ UMD USL APPIJCATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ O'IHI:R(PLEASE SPECIFYAROVE) <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 type MUST be selected. Fax fo (209) 4E4-0138 or mail to the <br /> address indicated above. . <br /> 2. EHD will notify the applicant if any EHD files axist. An appointment for review/will be confirmed <br /> approximately five business days but no later than ten (10) days after FOCeipt of application. The file:; <br /> will be held for a maximum Of five business days for review. Appointrrlents could 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 reorganizedby EHD staff at 1ha expense <br /> of the applicant Future file reviews by the same applicant may require: a 587-00 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:iS day. <br /> CONFIRMED APPOINTMENT DATE TIME _ <br /> DATE CONFIRMEDPHONE FAX INITIAL!; <br /> REVIEWED YES NO REVIEW DATE: <br />