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Dec 08 04 02: 37p Hanover ',Inc 530..-342 1450 <br /> la• 2 <br /> QATE REGf3 �'a f EHO LOG NuidBEft <br /> A�i JOiAdWIN COUNTYPU13LI0 HEALTH 5E CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC 8 2004 304 EAST WESER AVENUE,THIRD FLOOR. <br /> S°TOCKTON CA 95202 <br /> +� .� I - :� 1(209)468-3420 . <br /> T+1� IIYY 5L7 5 iT�T F�� .�`. 1 <br /> P BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 9USINES5IAGENCY H4 0vt1f" 6 <br /> ADDRESS ICJ=? a{rcEs.tir�e�rSY <br /> PHONE- 5` Z �✓ - FACSIMILE -^--' <br /> TENTATIVE''APPOINTMENT DATE t'� �� Tyle <br /> (Please give T to 10 business days from date of apP6061ion submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$81.00 FEE. +REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT ��+?/l•l>�jj" i DATE -- <br /> F <br /> FILE ADDRESS . IS SIDE EHD STAFF USE ONLY <br /> ROG I'LEMENTS SEARCH <br /> ?;.►AL�.. E. �GrY1O:lt 5"f,� ��aG�''t r ., - . <br /> -0Z !J. An'+`G fD s <br /> 2tCL9 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> I4-UNDERGROUND TANK(UST)CLEANUP SITE(LOA) n ROUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> ! OTHER CLEMUP SITE(NON-LOP) M FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND YANK(MONITORINGIREMOVAL) EI DOG KENNEL 0 DAIRY <br /> C'] HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PF_RMtTTED FACILITY 0 MOTELIHOTEI. 0 PUMPER TRtJCK(YARDICHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING e3 POOLISPA "' C3 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 13 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 checking <br /> the appropriate box(es). At least one file type-MUST be selected. Fax to f249)464-0138 Qr mail to the <br /> ':address indicated above. <br /> 2, FHO will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but nb later than ten (10)days after receipt of application. The files <br /> wil�be held for a maximum of five business days for review. Appointments should be scheduled. <br /> accordingly. <br /> 3. A fife,that is actively being worked on by I=HD staff may not be immediately available for review. A new <br /> applic9tiori may be submitted when the file Is available. <br /> 4. Any fhir 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. *TENTA'i,FVE appointment dates must be confirmed with EHD staff. <br /> Appiicatic�;is received after 3;40 pm will be processed the next business day. <br /> I <br /> CONFIRMED APP0110TMENT BATE TIME <br /> DATE CONFIRMED PHONE. FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> rsH oo 14 GXM7ro9 <br /> .TOTAL P..01... <br /> 1 <br />