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08/28/2002 14:57 2095224227 GEOLOGICAL TECHNICS PAGE 01/01 <br /> a—e. —euul e7:14F'M FF" <br /> TO � <br /> SAN�dAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 3 <br /> 304 EAST STOCKTONCA95202RDFLOOR n���nl `\/ rn) <br /> (209) 4683In 420 \V I_tJ <br /> RUB IC RECORDS RELEASE APPLICATION AUG 2 9 2002 <br /> J ����-- <br /> APPLICANT,)i <br /> .c "" BU81NEMAGENCY <br /> ADDRESS <br /> PHONE `��'>-- -i,\.1 CA S 3 sR RMIT/SERVICES <br /> — ---i FACSIMILE <br /> TENTATIVE^APPOiNTMENTDATEW�\\ , ,� 't <br /> (Please ve TT t Dpt <br /> TIME <br /> "Ate of a IlgUon 6ubm1Us1J <br /> CHECK BOX TO EXP!<'DITE QU T•$87, 0raE- TPROCEEDI I 3 BUSINESS DAYS p� I <br /> SIGNATURE OF,APPLICANT DATE <br /> i l <br /> FILr ADbRE83 <br /> THIS AIDE END$TAFF USE ONLY <br /> o <br /> PROGRAM ELEMENTS SEARCH <br /> i <br /> � tea✓ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITZ(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> % OTHER CLEANUP SITE(NON•LbP) ❑ F00o FACILITY ❑ SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MON#RINWREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> a HAZARDOUS WASTE GENERAttOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> M TIERED PERMITTED FACILITY M MOTIaLIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> L3 TATTOCIEODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Cl PUBLIC WATER SYSTFM M OTHER(PLEASE SPECIFYA8OVE) <br /> 1. List up to ten addrbsses in the space above.\Select the type(s) of files from the list above by checking <br /> the appropriate bok(es). At least one file type MUST be selected. Fax to (2D8)464-0138 or mall to the <br /> address Indlgated above <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be Confirmed <br /> approximately fivelbusiness days but no later than ten (10) days after receipt of application. The file$ <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may b submitted when the file is available. <br /> 4. Any file not returnd In the Game condition as released will be reorganized by EHD staff at the expense <br /> Of We applicant Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. *TENTATIVE appoihtment dates must be confirmed with EHO start. <br /> 6. Applications re0eiVCd after 3:00 pm will be processed the next business day, <br /> LEDATECON <br /> D APPOINTMEN:DATE <br /> TIME <br /> MED PHONE FAX INITIALS <br /> YESNO REVIEW DATE <br /> TOTFIL P.01 <br />