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DATJun . 25 . 2003 1 :41 PM CONDOR EARTH TECHNOLOGIES k :e,1)710GNO iii <br /> anlr wrlt,tumt COUNTY <br /> EN4 JNMENTAL HEALTH DEPARTME. <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> WT,1)l-_ )i)'ir)ifAi. HEALTH, STOCK,rON CA 95202 <br /> CF WIP.F (209)468-3420 <br /> PUBIC RECORDS RELEASE APPLICATION <br /> APPLICANT M f c,1-4 P—Lt N E 1 BUSINESIi/AGENCY IJbOiZ �:-1t1I �)' <br /> ADDRESS/' 18 H\� FP A.ty1 {N E C 1 RGL.C•: {STI+ T I—C-K V0 N1__. <br /> PHONE j� �I ) .2-3.4 — 0 rp 1 FACSIMILI: 23z4 -- d <br /> TENTATIVE`APPOINTMENT DATE <br /> y 2QQ3 nME <br /> —t­ <br /> _— ,- h U <br /> (Please give 7 to 10 bush days from date of application sutura ittal), ' L <br /> CHECK BOX TO EXPEDITE REQUEST-E BO E-RE ;iT PROC• 33E4 IN 3 BUSINESS DAYS'A J�1 <br /> / /// v^ . <br /> SIGNATURE OF APPLICANT . . _ D4TF <br /> r r i - <br /> FILE ADDRESS THIS Si13L:9iIR i SYAFF US:E 0N1.Y — <br /> PROC R4 ,M EL 94I7.I41S SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT �Y-;01 Ib vI ASTE r-ACI LITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD f ACILITY ;,OL.ID W ASTr VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KtiNNFL ❑ DAIRY <br /> ZA <br /> Ds HARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TRXATML"NT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELHOTEL ❑ F'Up�IPEFt TRtfCYJYARD/CIIEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING O POOVS PA ❑ LAPID MIZ APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE <br /> 1. List up to ten addresses in the space above. Select the type(s) of file-,.fl om-:he list above by checking <br /> the appropriate box(es). At least one file typo MUST be selected. Fax to20!I 4fi4•-01:38 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review wilt be confirmed <br /> approximately five business days but no late•than ten (10) days after re..eip-of 4pplic2tion. The fifes <br /> will beheld for a maximum of five'business c ays for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immed ia0ly F.valOabW for review. A new <br /> application may be submitted when the file in available. <br /> 4. Any file not returned In the same condition an released will be reorganizod b II END staff at the exponse <br /> of the applicant. Future file reviews by the saline applicant may require Z' $8_.00 deposit plior to review. <br /> 5. 'TENTATIVE.appointment dates must be con"Irmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be PI'Deessed the next businelis day'. <br /> CONFIRMED APPOINTMENT BATE � TIME <br /> DATE CONFIRMED PiONE FAX INITIAiLS <br /> REVIEWED YES NO REVIEW DATE 1 <br /> — <br /> vnenon� <br />