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1.0/13/2002 23:37 17078773276 ANTON GEOLOGICAL PAGE 02/02 <br /> 09-04-zexu1 014:25"' tah. — I U 1'MrCln'?Cfq r.lu <br /> ) tQ�11 COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL. HEALTH DIVISION " <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOClt70N CA 95202 <br /> O (209) 468,7420 <br /> I PUBLIC RECORDS RELEASE APPLICATIO r� <br /> APPLICANT Y�(C F,DU3INEWIAGENCY <br /> 4DPRESS no. QvX 37�� I.�[!!f� dA qVS Z IJ 0C T 1 4 2002 <br /> LHON .+ 70�-4317�- 3z 75f rI�ACSIIMILL <br /> . _ 7L> <br /> -7S-77 - 307/ EPS <br /> H <br /> TENTATIVE'APPOINTMENTOATA; 17 ' O ]/UM1T/sF�vicESLtTIME <br /> (Pica7 co in ss ds s n dot aPOtica' n subtnllWU 'T <br /> CHECK DOX TO,EXPEE)ITE RE4UEST-$a7 - C�SSL'CftiO 403 ESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z0 y3 O'L <br /> I ' <br /> FILE ADDREISS <br /> THIS$IDC EHD STAFF USE ONLY <br /> PROOKAM ELEMENTS$IARCH <br /> l03 � TaLrIctNJ _ <br /> 2151 vTyj TaC4e v <br /> Zvi Q„ri <br /> i . <br /> I <br /> ENVIRONMENTAL HEAI.TH DIVISION FILES <br /> UNDEjRGROUNO TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 50LID WASTE FACILITY <br /> OTHFjk CLEANUP SITE(NON-LOP) 4 FOOD FACILITY G 5ou8 WASTE VEHICLE <br /> UN0J3Rr,RQUHD TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARPOU3 WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERUD PHRMITTFsD PhCILITY O MOTEL/HOTItL O PUMPER TRUCKIY,ARDICNEMTOe..ETS <br /> 3 TATTQOIDODY PWRCING O POOUSPA 0 LAND USE APPLICATION SITES <br /> M6DIfAL wASTQ FACILITY D PVIILIC WATER SYSTEM O OTHER(PLLA$r SPECIFY ABOVE) <br /> 1. List up to ten addressor in the space above. Select the type(s) of files from (he list above by ehocidnq <br /> the appropiiato boX(eS): At least one filo type MUST be Selected. Fax to 464.0178 or mail to thg! <br /> addre3s.indicated above. <br /> b. 1 EHD will notify the applic:lnt if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tan (10) days after receipt of application.-The files <br /> i will be hula for a maximurti of five business days for review. Appointments should be scheduled <br /> I accordingly. <br /> 7- ' A filo chat Is actively being worKcr on by END staff may not bo immediately uvailablo for reviow- A new <br /> i application May be submitted when the filo Ia Available. <br /> Any (119 noCreturned in tho same condition as roleascd will be roorganlzad by EHD-staff at the expense <br /> of the applicant: Future flip reviews by tho same applicant may require a$07.00 deposit prior to raviaw, <br /> 'TENTATIVE appointment.dates must be confirmed with EHD staff. <br /> >: I Applications received after 3:00 pm Will be processed the next business day. <br /> -.ONFIMED APPOINTMENT DATE TIME <br /> DATE Ci iONFIRMED PHONE FAX INITIALS <br /> tEeV,�VIfED ; YES NO REVIEW r)A*rF ' <br /> TOTFL P.01 <br /> r <br /> s <br />