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SANQUIN.C�iUNTYPUt3LIC `Hr-ALii•I V'ik a <br /> WVIRONMENTAL HEALTH 1XVISI <br /> (VAR 1 3 20�) 304 EAST WEBER AVENUE,THIRD FLOOR Q n (� <br /> SFacKTON CA 95202 �J 1 <br /> +LTA (209) !,-}468-3420 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I � <br /> A 1i <br /> A`11-N I In-4>4 BUSINESSIAGENCY _ <br /> 3-7 9&0 rPOadi S-6000-AL, S 1 S w <br /> ao9 h'rn'7-/Df7ra FACSIMII-E r - <br /> TENTAT7VE'APPOINTMENT DATE F,r, . , 77ME <br /> (Piwse give 7 to 10 baso+ days&an date of application submittal) <br /> Oa <br /> CHECK BOX TO EXPEDRE REQUEST �? �FFqV RE EBT PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 I Z I <br /> FUZE) Ess <br /> I - <br /> v, ;j9Gd h% <br /> 9,1 <br /> 3Sd _ <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ,UNDERGROUND TANK(uEM CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOL10 WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASYE VEHICLE. <br /> uNDERGROUND TANK(MONrrOWNGIRFM0VAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACti- Y ❑ NOTEL/HOTEL ❑ PUMPERTRUCK/YAREUCHEMTOILETS <br /> A 7ATTOOVBODY PE19CING ❑ POOLI5PA ❑ LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ PUBUG WATER SYSTEM ❑ OTHER(FLEASE SPECIFY ABOVE') <br /> 1. t.ist up to ten addresses in the space above, Select the type(s)of tiles from the list above b checking <br /> the appropriate bcx(es). At least one file type MUST be selected. Fax to 2 9 5138 or riall to the <br /> address indicated above. <br /> 2- EHD will notify the applicant if any END riles exist. An appointmentfor review Y411 be conn ed <br /> approximately five business days but no later than ten (10) days after receipt of apphIcation The files <br /> will be held for a maximum of five business days for review. Appointments should be Scheduled <br /> accordingfy. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for reA iew. Anew <br /> application may be submitted when the file I9 available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at t le expense <br /> of the applicant. Future'fl)e reviews by the same applicant may require a $78.D0 deposit pri ir to review. <br /> S, *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g, Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INrTIALS <br /> REVIEWED - YES NO REVIEW DATE <br /> EH 09 14 11 a <br />