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01/28/2002 13:29 20946714 AGE STUCKTbl <br /> DAM RCC@1VW { � EH9 LOG NUMBER . <br /> ;11 JQUIN COU TYPUBLIC HEALTH SLIJICEs <br /> ENVIRONME TAL HEALTH DIVISION uIM <br /> 304 EAST WEB R AVENUE,THIRD > <br /> STO KION CA 905202 <br /> 468_342 <br /> PUBLIC RECORD a RELEASE APPLICATION--..--.-,.-'- , <br /> OM <br /> APPLICANT e. BUSIN SSIAGNCY <br /> ADDRESS <br /> PHO i l4V FAC51 IL£ <br /> 7:::! /' <br /> ENTATIVE*APPOINTMENT DATE TIME �r� <br /> (Please give 7 to 10 bu5me days from date of application submittal) JY <br /> GHFCK BOX TO EXPEDITF REQUFST-S7 0 FEE—REI] EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPI_IGANI PATE OZ <br /> FI F ADORtc55 . <br /> P-q <br /> ayS <br /> .(ao a> <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP 31TE(LOP) LI HO SING ABATEMENT 13 SOLID WASTE FACILm <br /> OTHER CLEANUP SITE(NON-LOP) Q FO D FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DO KENNEL C3 DAIRY <br /> HAZA DOUS WASTt GF-NERATOR O CHI KEN RANCH O PKG TREATMENT PLANT <br /> TIFl21;❑PEKMrITED FACILITY E3 MO LIHOTEL © PUMPER TRUcKIYARDICHEM•TOILETS <br /> 4 TATTOOIBODY PEIRCING 0 PO USPA LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY O PU LIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> �. List up to ten addresses in the space abo e, Select the type(S) of file$from the list above by checking <br /> the appropriate box(es). At least one fila ypeMUST be selected. Fax to 209 454-0138 or mail to the <br /> address indicated above. <br /> 2. EHE will notify the applicant if any EHD fi es exist. Ari appointment for review will be confirmed <br /> approximately five business days but no ater than ten (10)days after receipt of;application. The files <br /> will be held for a maximum of five busine s clays for review. Appointments should be scheduled <br /> accordingly. ' <br /> 3. A file that is actively being,worked on by HD staff may not be immediately available for review. A new <br /> application may be submitted when the fi a is available. <br /> 4. Any file not returned In the same COnditic as released will be reorganized by t_HD staff at the expense <br /> of the applicant. Ftature file reviews by th i same applicant may require a$78.00.deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be t onfirmad with EHV staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE . <br />'� ert ao s4 avosma <br />