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TEL lay 01 UU `, : �) 4 NO . LJU2 r . u � <br /> j ' rtu k4 6C vGu - F3W l4L: N N:N <br /> PP /Sp:� x4r- 0 0 SAI JAQUIN COUNTYPUBLIC HL-ALTH Rvims � - <br /> ENVIRONMENTAL. HEALTH DIVISION y <br /> 3U4 EAST W001SRAVENUE, THIRD FLOOR <br /> NTOCKTON CA952oz <br /> 7a ,L (309) 4W44Yo <br /> / <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT . afiIVAI 1] Al r, t6— aUSIMUSSIAOR11CY <br /> AVORESB <br /> PHONE f 416 - /7 '� 3y_ FArea UL1C2z3 Z/— 1 SQ T <br /> TENTATIVE' APPo1HSMEuT DAT11 _. TIYG <br /> Wleaae MY* 7 to ie buunam days from date of appaeatIon submtttr0 <br /> CI ICCK PDX TO CCPLDIYC RCQUCOT • $79.90 Jr'CC � RCQUCGT PRocCacCO IN 3 OU"rGG OAYG <br /> SIGNATURE OF APPLICANT ! Idc, DATE _ <br /> fl Siff OtD STAPP USa ONLY <br /> PROGRAM E1EIA�rN'I'8 -� <br /> Irr <br /> (Sis �' A. <br /> Q6e3 <br /> ,� ENVIRONMENTAL HEALTH DIVISION FILES <br /> ffi UHUERGROUND TAMC (USTI CLEANUP SITE (LOP) ❑ HOUSING ABATVAENT ❑ SOLID WASTP FACILITY <br /> 0 OTHER CLEANUP 917E (NOX10P) O FM FACIUTY 0 SOLID WASTEVEHiCLE <br /> WUNDERGROUND TANK (MONITORINGIREMOVAL) 0 POG tMNEL O DAIRY <br /> WHALARDOUS WASTE GMRATOR d CHICKON RANCH 17 PKG TITFATMEUT PLAWT <br /> YICRCOrdikN1Ir FACILrTY 1, G U9YELHOT!L Q I•UUPCA TRUGKFI'AMXf;nCM TVRGIa <br /> 0 TATYOWBOPT PEIRCII16 O POOLWA ❑ LAUD USE APPLICATIONS"" <br /> 0 MEDICAL WASTE FACILITY O PUBLIC WATFR AY37PM M OTHER (PLFASE RPECIFV AaOYR) <br /> 1 . List up to ten addresses ID the space above. Select the types) of files from the list above by checking <br /> the appropriate box(W)t At least one file type MUST be selected. Fax to (3Q@] 484«11138 or mall to the <br /> address indicated above. <br /> 2. EHD wEU notify the applicant if any END flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tan (14) days after receipt of #ppiicstiop. The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 35 A file that Is actively being worked On by EMD staff may not be )mmedlately available for review. A new <br /> application may be submittod where the file Is available. <br /> 4. Any Rfe not returned In the Serge Condition se released will be reorganised by Esu] staff at the expense <br /> of the applicant. Future Nle reviews by the game applieard may require a 578.00 deposit prior to review, <br /> ;t� "TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 'B. Appileationa received altar 3.04 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> (DATE CONF)RME0 PHONE; FAX INITIALS <br /> REVIEWED YES NO REVIEW OATH <br /> TGTRL P . BL <br /> I <br />