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10/14/2002 15:57 2095224_227 GEOLOGICAL TECHNICS PAGE 01/01 <br /> 01-23-2001 0L'14PM FRO�'' - ) TO 5385652 P.01 .1 <br /> SAN J QUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION . <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> I O I STOCKTpN CA 93202 <br /> (206)486$420 � i! <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT J nc..} `"�{. �+ �cra.�o �� BUSINESS/AGENCY <br /> . ADDRESS \\O k —Xk' STC, <br /> TENTATIVE'APPOIHTe1ENTDATE w� -,: Fo � TIMe <br /> (Phase give 7 to 10 EIde t>apptteaCHECK BOX TO EXPEDITE RtQUEST.$87.eD QROCEa9 <br /> p ENVPIERRONM E. R �ES�II, _ t <br /> 15 SINESS DAYS <br /> SIGNATURE OF APPLICANT u>4� DATE _1'3 J I't IQ a, i <br /> I <br /> PILEADDRESS - THI4 SIDE EHD STAFF USE ONLY j <br /> !L 1 PROGRAM ELEMENTS SEARCH <br /> atj N <br /> �1 \ 5< o <br /> ckA <br /> \, C Ir <br /> II I <br /> ENVIRONMENTAL HEALTH DIVISION FILES �I 4 <br /> If UNDEROROUNp TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> t% OTHERROUND SITE(NON-LOP) FOOD FACILITY ^ El SOLID WA3T1:vDHICLri <br /> UNDERGROUND TANK(MONM}y,RINO/REMOVAL) ❑ DOG KENNEL O DA82Y I <br /> it HAZARDOUS WASTE GENERATORCHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY CI❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> C7 TATTOO/BODY PEIRCING 13POOLlSPA El LAND USE APPLICATION SITES <br /> r 1 <br /> 13 MEDICAL WASTE FACILITY i ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOvE) `I <br /> I` I <br /> 1. List up to ten addr6les in the space above. Select th'o type(s)of files from the list above by checking, <br /> the appropriate bOjc(es). At least one file type MUST be selected. Fax to(209)4940138 p ail iv the <br /> address ind)cated 6hove <br /> 2. EHD will notify thelappticant if any END files exist. Ani appointment for review will be confirmed <br /> approximatelyflvcIbusinesa days but no later than ton'(10)days after receipt of applicatbn. The files f <br /> will be held for a Maximum of flue business days for review. Appointments should be scheduled <br /> accordingly. I <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 134 submitted when the file is available. <br /> 4. Any file not returnyd In the same condition as released will be reorganized by EHD staff at the expense <br /> Of the applicant FLture file reviews by the same applicant may require a;87.00 deposit prior to review. <br /> 8, "TENTATIVE appoihtment dates must be confirmed with EHD stall. <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 j E <br /> REVIEWED YES NO REVIEW DATE I� <br /> • n <br /> TOTAL P.01 <br /> e G <br />