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0/16/2004 16:20 FAX 209 9480621...' <br /> Z002 <br /> VA,>: ,� }111 <br /> 51� ��� AN JOAQUIN COUN7YRUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL Hill I <br /> IG 16 2004 304 EAST WEBER AV1 N IVF <br /> p Yjq57 <br /> A STOCK7ON CA <br /> ENVIRONMENT HEALTH (209)466-3420 <br /> PERI-o171SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTBj?a BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE. ;�o r 91$- /, s - FACSIMILE: <br /> �: OD• � � - <br /> TENTATIVE'APPOINTMENT DATE 8 Q TIME <br /> (Please gf"7 to iG business ddyS date of swjj ocn sulsrNttal) <br /> 9-1.co <br /> ftKHECK BOX TO EXpEDrrE REQUEST-;W.0 EE-REQUEST PROCEs ED IN 3 BUSINESS DAYS10 <br /> SIGNATURE OF APPLICANT DATE <br /> FIIF ADDRESS THIS SIDE WD STAFF USE ONLY <br /> pROGRAM ELEMENTS SEARCH <br /> I o/ '�t - <br /> fill ar °K/ 7_ <br /> oS1 c>" ✓ ry �foc r✓ d <br /> Leer ee•�ue fv� �, �2�-. <br /> grow <br /> 4c <br /> ENVIRONMENTAL HEALTH DIVISION FILES ' <br /> HOUSING ABATEMENT �Q S�OLID WASTE FAPUTY <br /> UNDERGROUND TANK(USS)CLEANUP SfTE(LOP) ❑ FOOD FACLLITY J9-SOUD WASTE VEHICLE <br /> O'(}lER CLEANUP SITE(NON{-OP) 12 DOG KENNEL .K DAIRY <br /> UNDERGROUND TANK(MONITOREE�EGIfiEMOVAL) c3 CHICKEN RANCH )OL FillT�TM�PLANT <br /> XHAZARDOUS wAST'E GENERATOR n MOTELIHOTEL IO PUMPER TRucKrYARDICHEE�I TOILI=TS <br /> TIERED PFRMITT FACILITY ❑•POOUSPA X'LAND USE APPLICATION 51TES <br /> ❑ TAT'o(WBODY PIERCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> Y <br /> List up to ten addresses In the space above. Select the types)of files from the list above by eheCldn9 <br /> 1. box(es). At least a file type MUST be selected. ax to 209 6"138 or mail to the <br /> the appropriate <br /> address indicated above, . ointment for review will be confirmed- <br /> 2. EHU will notify the applicant if any EHD files exist_ to apo days after recelpt of.application. The files <br /> approximately five business days but no later than ten( ) Y olntmentS should be scheduled <br /> will be held for a maximum of five business days for review. APP <br /> accordingly. <br /> 3. A file that is actively being worked on tay EHD staff_May not be immediately available for review. Anew <br /> application may be submitted when the file is availableEHD staff at the. <br /> 4. Any file not returned In the same Condition as released will be reorg ed' y 4 degosit prior t Xpease <br /> en <br /> Se <br /> of the applicant. Future file reviews by the same applicant may reg ire <br /> 5_ 'TENTATIVE appointment dates must be confirmed with <=HD staff. <br /> Ill will be processed the next business <br /> g. Applications received aftor 3:04 pday. 3.. <br /> CONFIRMED APPOINTMENT DATE TIME, <br /> DATE CONFIRMED PHONE FAX 1NITWLS —� <br /> f ,,,. o�rrcur nem <br />