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DATE RECEIVED EHD I,OG NUMBER <br /> SAN JMkQUINCOUNTYPUBLIC HEALTHgKRVICES <br /> "ONMENTAL HEALTH DIVIS w 1 -) 9 <br /> , 4 ST WEBER AVENUE,THIRD FLOOR <br /> r ` T CKTON CA 95202 <br /> � 5 AN 2 2002 s o <br /> (209)468-3420 <br /> ENVirMMIEN" HEALTH PUBLIC RECORDS RELEASE APPLICATI <br /> APPLICANT BUSINESS/AGENCY &Pmo X <br /> �f f <br /> ADDRESS -- D 1 % ``�� C�c <br /> 4 J i <br /> PHONE 't 4""i LQ -q4 J a FACSIMILE <br /> �Ji - j 1 :30)0 2- TIME i 2"dD_ d <br /> TENTATIVE*APPOINTMENT DATE u� <br /> (Please give//7 to 10 business days from ate of application submittal) <br /> C_ k/ <br /> 1:21/CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUET PROC SED IN 3 BUSINESS DAYS <br /> /eD F,)— <br /> SIGNATURE OF APPLICANT DATE l <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> J ' <br /> 3 <br /> .40 <br /> r} - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> f�NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 4/OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ��NDERGR OUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ARD00 WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRl1CK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space•�tbove. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to.the <br /> address indicated above. <br /> 2. EHD 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 ten (10) days after receipt of application. The files <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. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD 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 dates 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 />