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r�1 PHONlz IJJ. : 209 369 4220 Feb. 09 2000 09:09Ar P2 <br /> SAN OUIN CpUNTypUBLIC HEALTH SERVICES <br /> ENVIRONMFNtALhEALTNDIVISION <br /> 304 EAST WEBER AVENUE.THIRD FLOOR <br /> S"TOCK70N CA 95202 <br /> (203)468-3420 <br /> PUSLIC RECORDS RELEASE APPLICATION <br /> /� <br /> ADDRESS /YI YJ/YC-,�il'1 fi <br /> TENTATNj •APPOINTMENT PATE <br /> (Pfau.pivQ 7 to t0 4uslnenc ay,rra+n sun ora nt1E <br /> aW2aocra aul�mlual) <br /> CHECK ROx TO EXpeolre REOUE3T•Sta.00 FA. <br /> REQUEST PROCEESEO IN 3 BFI IXESS BATS <br /> SIGNATURES OF APPLICANT _ <br /> DATE jTJ�J� <br /> re.e AODREa3 �==sex. <br /> ��t 1'V)IYAv-ice r- i <br /> ? <br /> 3 <br /> c - S <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ','-4'UNaERGROUNb TANK=T)CLFANUA 3rr6(LORI C HOUSINCABATLMEW SOLID WASTE FACILITY <br /> 0 OTraft CLEANUP Une(NONiOP) ❑ p <br /> UNUBRCRCINiD TANK[MONITORMQ'RZ;A{OVgl,J ❑ A� d SOLID W=TE VEWICIF- <br /> PChALAROOW WASTE GENEIIATOR NNEL (3 DAIRY <br /> C T"EO PERNRTE'D FADW:Y MO PCIPCEN R n !'KO TFtLATVMiT PLANT <br /> 171 TATT00WDY pf;=fNO t7 ClMorevPA O 0 PIIWER TRUCMAR6CHEM TOILETS <br /> d NEDICALWASTE r'AcuiTY 13 POCI WATER SYSTEM 13 <br /> NAW USE APP=T;ON SITES <br /> OTHER(PLEARV SP=Fy ABOVE) <br /> I- L131 Up to tun addreatat in the spaces above. Select the s <br /> ppropriate box(Os)- At least one fie �( )of llles from the flit above by chacking <br /> thea typo MUST be Selectfrom <br /> t F7+)tto(20814FA-0t;.j8 or ma%to the <br /> 2. SHO �no�Y-�PP 1car'E if any EHD files a)dst. An aApolnfinent for review will be confirmed <br /> aPprox(freeiy five buslneez dayc but no later than ten(10)days aft*t roecipt of application- The Plot <br /> w111 be hold for a msx4nwn of five bu3inOss days for rOvtaW, Appointrnients should be scheduled <br /> accordingly_ <br /> 3. A file that is a(:b'valy 13e311,9 worked on E <br /> aPP"cation MaY he SUbMitted when the filaH�vra17 1aff a not be,mrttediate}y avallahte for rovinw. A new <br /> 4- Any file hot returned In the <br /> an <br /> of the eppthcant. Future fila�reviome w Condition <br /> n r*Ieased will he reorganized ey _HD staff at the ozprnse <br /> S. 'TEIRTATIVE appolrttrnont dates must T carne applicant May rOquire a$78,60 deposit pr,to ravlew_ <br /> 6' ApplicaUon3 racehed after 3r0U pm w%1 b0 nflrmed with EHD stsff- <br /> proce3agd the next bUSinEaB day. <br /> CONFIRMED APPOINTMENT DATE {{{ <br /> TIME { <br /> OAT E CONFIRMED I <br /> I <br /> PHONE FAX INIT(ALS— <br /> REVICWEID <br /> YES NO REVIEIV DAY6 <br /> TOTAL 7,$1 <br /> P, <br />