Laserfiche WebLink
SAN JOAnUIN COLINTYPUBLIG HEALIM 71~K�It;tM� <br /> E 11RONM,ENTAL HEALTH DIVISION <br /> aKEA ST WESER AVENUE.THIRD FLOOR <br /> STOCKCON CA 95202 <br /> (209)468-3420 <br /> -' PUBLIC RECORDS RELEASE APPLICATION <br /> Rr'PLiCANT �t'�b,- � GLbi _ BVSiNFSSIhGEt�CY � 1'1��1�. riV1�f[>y1Y1+`Y1 � I�1, �icli <br /> ,aapR>=ss - 7 0 erkin$ ret.{" �rr�orr+ CA954`7 11J11� o LL <br /> PF[gNi~ -lO"Z) � 4rg FACSIMILE `�Cs`7 � gZ 2 - ��49 ` N CD <br /> _`w <br /> TENTATIVE'APPOINTMENT IJATE _WLIi, U3-n_'_2-4 TIME to 0 d aM- <br /> (Please give 7 W 10 business days Horn date of application submittal) Q C-_ <br /> CHECK BOY.TO EXP EMTE REQUEST.S87.00 FEE-REQUEST PROLE 55£D IN 3 SUSIXESS DAY$ u <br /> SIGNATURE OF APPLICANT - DATE 1- 2-2--01 <br /> FILE ADDRESS THIS SIDE E14D STAFF USE 014LY <br /> PROGRAM ELEMENTS SEARCH <br /> 77 1C U °Sp l INc+s k IC+C1ZYr►2+► l- �+,c b-4c�i 0 <br /> l <br /> euro+-� r 301 Wes+ K&4evnz*% LAY-6, L_d i <br /> lJ�ti at�,rtia,� � #�ti tt�' Y�•tkl�vr►Ja+I t-.zr� 1..ed: � <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> U'/UNDERGROUND TANK(UST)Cf_F_ANU?SITE(LOP) Q HOUSING A$ATEMEKY ❑ sour)wASTE FACILDY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACIL17Y U SOJJD WASTE VEHICLE <br /> ❑ IJ11DERGROUND TANK(MONITORING/REMOVAL) ❑ COG KENNEL ❑ DAIRY <br /> ❑ HAEAARaOuS WASTE GENERATOR, ❑ CHICKEN RANCH t] PICC TREATMENT PLANT <br /> ❑ TIERI=D PER1ArrTEA FACILITY ❑ MQTEUHQTEL C3 PUMPERTfWCWYARDICHEM TOILETS <br /> a TATT001BODY PEiRCING Q PoOUSPA ' • Q LANO USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFYABOVE) <br /> 1. List up to ten addresses in the space above. $elect the type(s)of fifes from the list above by checking <br /> the appropriate box(es). At],east one file type MUST be selected. Fax to(209).464-0118 or mail to the <br /> _address indicated Ab9ve. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review%%0 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 S maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD 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 EHO staff at the expense <br /> of the applicant. Future file reviews by the sane applicant may require a$87.40 deposit priar to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMM APPOINTMENT DATE xiME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RE <br /> Gtl vVIEWED YES NO REVIEW DATE _ <br /> EH <br /> TOTAL P.01 <br />