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04 / 30 / 2003 09 : 42 FAX 209 9480821 <br /> I <br /> Q1002 -- 003 <br /> DATE RC[ J I END U>G mumaE <br /> X1)51 � � ! I �1 SIF ) lb�'.N JOAWuIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 3 0 2003 304 EAST WEBER AVENUE, THIRD FLOOR J <br /> ST (209) 46 3 95202 I / <br /> - NV! Rui,iMLPJT NLAL (zD9) a6a.34zo <br /> _ _ - I- , I.4t ' �' Fl< FS yBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTBUSINE.SSIAGENCY 7+ :� / " /ra.nyt.�G+ /.� .�,Ge I' d r.- <br /> 'd --a,,,, -• <br />�. � <br /> ADDRESS . _ --. <br /> PHONE FACSIMILE 9618 — D115 -'— / <br /> TENTATIVE' APPOINTMENT DATE S � % � 3 TIME <br /> . (Please give 7 to 10 business days from date orappllration oubmittafj <br /> CHECK BOX TO EXPEDITE REQUEST - Se7.0e FEE REQUEST PROCESSED IN 3 BUSINESS DAYS ' <br /> SIGNATURE OF APPLICANT iZ��v� „� DATE <br /> I <br /> FILE pDORESS THIS SIDE: EI10 S iS 'AFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> / 6076 tur+ r Llv& AIvL <br /> / � o - r � i {• -- <br /> Clv6 <br /> 10 3 <br /> Cs <br /> mV;k 74 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ..1B'uNDrRGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ �SSffILID WA>TE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY H'S(ILID WA$TE VEHICLE <br /> 2TNCrRGRoUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL CI DlJR'I' <br /> HAZARDOUS WASTE GENERATOR. ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCKfYARDICHEM TOILET:i <br /> ❑ TATTODIBODY PEIRCING ❑ PQOLISPA ❑ LI,N[I USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM 0 07FIFFR (PLEA:iE SPECIFYABOVE) <br /> 1 . List up to ten addresses in the space above. Select the type(s) of files frim the k4 t above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to f20� a64 0938 or mail to the <br /> ddress indicated above. . <br /> 2. EHD will notify the applicant if any EHD files (exist An appointment for reviev+ will be Confirmed <br /> approximately five business days but no later than ten (10) days after u3ceipt ofrtpplication, The filo:; <br /> will be held for a maximum of five business days for review. Appointments would be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately a'railable 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 requiro 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:is day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX T INITIALS <br /> REVIEWED YES NO REVIEW DATE; <br />