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FROM t li IH Err. i rorrnen ta7 PHGNE t10. : x'13? .?E'? 42 ' Plar. 16 cb�UfJ 11:J:fJSHM P1 <br /> O� SA*ARUJN COUN7YPUBLlC HEALTH Se OcEs W�yM�EF <br /> ENVIRONMENTAL HEALTH OIVtSION <br /> 304 EA6T WE AVENUE.THIRD FLOOR logo <br /> SfOCKCK70N Ca r0202 <br /> (209)468-34M 00 <br /> PUBLIC RECORDS RELEASE APPUCATION <br /> APPUCANT '•1 V O �' 'C+� Y'�C'lr1 t� <br /> 9USiN(,S,yAnENC7 �t <br /> ADDISb 22- <br /> PHORfr 2-0C1 - FACMMR.E <br /> TENTATIVL:" pLplN7Mrr,vT0ATE <br /> (Pta�taint 7 tO 10 WA'04"6a ■frarn e7b et T1UE «. 1 <br /> T +ppic+tim�a9numq eR�` <br /> r-' CHECK BOX TO kXP!n.TE REQUEST-ST7.00 FPS_ p -SrP 8[b INT SU51NF,SS t7SYS U <br /> 51GNATLJRE OF APPtaCANT t, f�• (� f l( On ,� ,pr <br /> DATE <br /> P4E A[)nRlaE <br /> h-j4�i AQ <br /> 51 f/Cn <br /> OL <br /> -r <br /> (7 e-5 <br /> ENVIRONMENTAL HEALTH DMWON FTLEs <br /> 14UNDPRGROUND TANK(LIST)CLEANUPitT6 t4Qpj ❑ 4NmNUABATzwaN7 ❑ <br /> aT1 R CLcAIiUP SITE(NON10P1 ❑ POOR r-ACILITT ❑ SOLD WASTE PACC.1 E <br /> UNOERGTtOUtlt)TANK 1NOlu'rORattilN�Jaavgy ❑ 000 MMEL ❑. ammy WASTE VfNKa.E <br /> NAZAatg riAdTH Glf1ERATOFt MIRY <br /> TIBRtD PERMITTED lACIL.f 4 tdd0TMMOUCKENW�I M PUMPER TRUM T PLANT <br /> ❑ TATTt1WBODY P6aiCAc6 � PUMPER TRUCkfYARl7lCFI[►t 7oa.E73 <br /> ❑ UWCAL WASTE FACjMy t3 POOUSPA M LANU UCSL'APPLICATION SrrES <br /> ❑ PUltuc WATER E"TEN Cl OTWR(PLEAS!U%Ctry AaDvE) <br /> T- List Up to fan addraatas in the space above. SateW the typt•(a)of files from the list above by checking <br /> the appropriate box(as). At least ono file typo MUST be selected. EM-to=21464.01"or mall to the <br /> �drase Indlsrsted above, <br /> 2. EHD will notity,the appllcant 11 an EHO flies exist An <br /> y appointment for review win ba confirmed <br /> appmIlmately(lye busfness days Dui no lator than ten(101 daya after receipt of APPiicatlon. The fftas <br /> win be held for a maximum of fixe business days for rovlety. APPointments should be scheduled <br /> acaotci&tgly. <br /> 3. A file that is aatively boing worked on try ERR stag may not be Immediatefy w"llable for rfwiaW. A new <br /> aPPNcaUon may be Submitted when the fiie Is avaNabla. <br /> 4 Any file not returned In the Wmo condition as released will be roorgarjz d by ERD staff at tha oxpenee <br /> of the*TENTATIVE <br /> p Future file reviews by life tame applicant may require a$76.00 citpoait prior to Mview- <br /> 5. 'TENTATIVE appolnlmottt datoa must be confirmed with END staft. <br /> S• Applicationa received after 3.06 pm will 4 processed the next businuss day. <br /> CONFIRMED APPOINTME.4T DATE TIME <br /> DAT>;CONF1RMEp PHONE FAX INITIALS <br /> I <br /> REVIEWED YES <br /> N6 REVIEW DATE ' <br /> TOTfi P.01 <br />