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kao . l4 . 2003 4: 02PM CONF0EARTH TECHNOLOGIES No - 4644 P. 1/1 Hlyg <br /> OA�REC�VEn <br /> 4(r, vy'^ EH0 LOG NUMEft <br /> nLA\4 SAN JOAQIJI QIlH.t7YRU 41CI HEALTH SERVICES <br /> c i'•. ENVIROFiNI8NTAJ2e'4ffA- LTH DIVISION <br /> 304 EAST WEBERAVENU THIRD FLOOR <br /> 03 AtddxT818 c , €tz02 <br /> ) 468-3420 lq3 ; <br /> PUBLIC RECORDS9RELEASE APPLICATION <br /> APPUCANT_d,,C;� <br /> ADDRESS l V V "�tIZ ��-P S�T �i 1Zt-CJ' �1 1^���-�•.GI_�� `' <br /> PHONE _ L FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE 4 f-t'V�VS� Cid NNE DO A--Yy� <br /> (Please give 7 to 10 businesskdiya from date of application submittal) <br /> K--+ CHECK 90X TO EXPEDITE REQUEST•587.00 FEE—R$QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `z DATE I't t-(t�- • 03 \' <br /> i <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH - <br /> aglss /V. igwv 9.9 FRe 7+96-E AaAmPc <br /> Ll <br /> a q <br /> d <br /> S7 wAq 77 ✓ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT 0--SOUD WASTE FACILITY <br /> BOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> 03uND£RGROUND TANK(MONTTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR O.CHICKEN RANCH 4 PKG TREATMENT PLANT <br /> ff3-TIERED PERMif i FACILITY ❑ MOTEL/HOTEL 11 PUMPERTRUCKfYARD/CHEMTOHFiS <br /> ❑ TATTOOBOOYPE3RCING ❑ POOL/SPA ❑ LAND USEAPPLICATiONSITES <br /> ❑ MEDICAL 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 checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mall-to the <br /> address )ndlcated_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 tater 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 an by EHO staff may not be immediately available for review. A new <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 EHD staff. <br /> 5. Applications received after 3:00 pm will be processed the next business day. ` <br /> is . .„ ., <br /> `i ) <br /> ;ONFIRIIED APPOINTMENT DATE TIME <br />