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f 03/07/2002 12:51 FAX 209 998 0621 KLEINFELDER 21002/002 <br /> r DATE RE-COVED , EHD LOC NUMBER <br /> SAN AQUIN CQUNTYPUBLIC HEALTH RVI CES- <br /> ENVIRONMENTAL.HEALTH DIVISION <br /> r'`; ;tl HE Al-1[804 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCK170N CA 95202 <br /> ;f <br /> (209)46$-3420 <br /> 02 MAR -7 PRUMC RECORDSAELEASE APPLICATION <br /> v '-'e- <br /> I. <br /> APPLICANTS . 4« BUS I . I � � j'�,r- <br /> INESSlAGENCY <br /> ADDRESs4iY� <br /> PHONE `7 � f �I FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE Ila /0 <br /> (Please i 7 to.10 b iness day om d of appll on submittal) <br /> CHECK BOX TO EXPEDrM REQUESTO�EE RE UEST PR D 3 B ,SSDAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> FILE ADDRESS THIS SIDE,EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> w{39Y f. s`l- _ - �'FGGGc-fan CA <br /> I 10 1'j ;1 be►rf- Sf <br /> CA <br /> 4 G 4 <br /> .253q <br /> -716 15 e,- 352 ; <br /> ! ENVIRONMENTAL HEALTH DIVISION FILES <br /> 07 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT /_ �`.SOLID WASTE FACILITY <br /> WOTHER CLEANUP SITE(NON-LOP) FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> CVUNDERGROUND TANK(MONITORINWREMOVAL)� ,❑ DOG KENNEL. l7 0AIRY <br /> rg"HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH Z PKG TREATMENT PLANT <br /> W'TIERED PERMII7ED FACILITY ❑ MOTELIHOTEL M .PUMPERTRUCWYARD/CHEM TOILETS <br /> d TATTO01BODY PEIRCING Cl POOUSPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEM 0 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 209) 464 0138 or mail to the <br /> address indicates(above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review 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 END staff may not he immediately available for review. A new. i <br /> application may be submitted when the file:is available. <br /> 4. Any file not returned in the same condltlon: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 /> S. "TENTATIVIw appointment dates must be confirmed with EHD staff. <br /> B. ' Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS _ l <br /> REVIEWED YES NO REVIEW DATE � <br /> e" no 14 aEla m <br />