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04//10/03 THU 13:02 FAX 925 253 4985 - TREADWELL & ROLLO IE>)001 <br /> ?Ir SANJOAQUIN COUNTYPUBLIC HEALTH .VICEE: �OtpG Mt MpEN <br /> APR 1 0 2003 ENVIRONMENTAL HEALTH.DIVISION I <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONMENT HEALTH ST(209)459-3420 02 Fuin. Y,: (Zt'-:5yz2— <br /> PFRMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �7 .r� BU1SINESSIA ENCY r• ;-/'�/4� <br /> V' ADDRESS eC_ IIALei-M -)cl s �li'tP ZI(o ncnrXa ��dti.-- � � <br /> PHONE. 925-Z.53-y980 Xd411v Fse E <br /> (� -. -� <br /> { P..l l ,z�- or. �- <br /> TENTATIVE*APPOINTMENT GATE 03 TIME <br /> ' (Please give 7Iv touc <br /> blnoss days from dale of appllcatlan subrnlUal) <br /> CHECK BOX TO EXPEDITE REQUEST 9.00 FEE-REQUEST PRO SED IN 3 BU IN S iAYS <br /> j SIGNATURE OF APPLICANT I .,1' - .(�QATI1 �E-a= ' <br /> FILL ADDRESS THIS SIDE END ST,4FF USE ONLY <br /> PROGRAM ELL-MEff SEARCH <br /> y wr-- a e T SIWV i <br /> -- <br /> w enA <br /> 4 _ <br /> 74 vJ�yk uL <br /> 4-7 we.Si Q l <br /> X315 T vaf ra ' IG �. <br /> ENVIRONMENTAL HEALTH DIVISION FILE5 <br /> t4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING AUATEMENT O SOLID WASTE FACILITY <br /> OTtiER CLEANUP SITE(NON-LOP) 0 FOoo FACILITY O SOLID WAS71 VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL). Q DOG KENNEL 0 DAIRY <br /> HA7rARDOUS WASTE GENERATOR Q CHICKEN RANCH .0 PIs:G TREATMENT PLANT <br /> TIERED PERMIYTED FACILFY O MOTEU"OTEL O PUMPER T1IUC:KNARDAC HEM TOILETS <br /> • TATTOO/BODYPetRCING 0 POOLISPA O LonND USE,1011LICATION SITES <br /> O MEDICAL WASTE FACILITY } 0 PUBLIC WATER SYSTEM O OTHER(PLE.ANE SPECIFY ABOVE) <br /> 1. List up to ton addresses In the space above. Select the lype(s) of filrs from the list above by chocking <br /> the appropriate box(es). At least one file type MUST be selected. FaX Lo 209 46"138 or mail to ILO <br /> address indicated above. <br /> 2. EHO will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than len(10)days aftor raceipt of applicJtion. The files <br /> will be held for a maximum of five business days for review. Appolntments should be scheduled <br /> accordingly. <br /> 3. A file thatls 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 releaser{will be reorgnnlxod by 17-HD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5_ "TENTATIVE appointment doles must be confirmed with EHD staff. <br /> . 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ar.TOhQfi Tb:DT 7aa7i:Tr/TT <br />