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SAN *QUIN COUNTYPUBLIC HEALTH VICES <br /> NVIRONMENTAL HEALTH DIVISICK <br /> faiAY Z �;� )� 304 EAST WEBER AVENUE,THIRD FLOOR <br /> - <br /> MAY 46 -3 95202 h� _ O <br /> (209) 468-3420 (d.EG� <br /> F h Llfi PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT HUSINESWAGENCY CC-k7 CLOY 1'C ,AlG 7C�dbea <br /> PHONE �7n�l--o"73Sr^ CJ.�/S FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE //�O <br /> (Please give 7 to 10 business mays from date of appli,,,nm submittaq <br /> El CHECK BOX TO EXPEDITE REQUEST�-; 7.00�FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Vie¢ /rf -c DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 'Yb ( .f. <br /> W.{ <br /> I l�UrrcVGJ f-LI�nYOA/J <br /> 'flO -f �.lt t'YTr'b <br /> Saa 1 ( 1 D4 ,je %yT��� a9G o �9-s3 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) ❑ HOUSIHGAaATEMENT K SOLID WASTE FACILITY <br /> ,tQ.OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEIJHOTPL ❑ PUMPER TRUCKIYARDfCHFM TOILETS <br /> ❑ TATTOOIBODY PEIRCING E7 POOLISPA ' g LAND USE APPUCATION SITES <br /> ❑ UPPICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by chocking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mall to the <br /> address indicated above <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for roviaw will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should 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 now <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 require a$87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with END staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />