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FED-25-03 12 :54 PM P.131 <br /> B-)- PAI <br /> 2,lr 4,.- HEAL* <br /> 25! ENVIRCUVE�-r <br /> c1lu 1�"VolF.11 <br /> SA7N-' OAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> FEB 52 ENVIRONMENTAL HEALTH DIVISION <br /> 003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONi'Vff-ly- STOCK-rON CA 95Z02 <br /> PFRA," (209)463.3420 <br /> )T/ 04//Cj-pdkIC RECORDS RELEASE APPLICATION <br /> APPUCkNT W ousiNnstAuNcy <br /> -- <br /> �A <br /> ( <br /> PHONE <br /> � _61 <br /> Ad3imm <br /> e <br /> 76 TENTATIVE-APPOINTMNTDATE <br /> TIME <br /> 3L <br /> (Pte is*give T to ib business days from dale of appfti(fon suisnitta) <br /> 'a' <br /> C14ECK SOX, TO kXFEDITE;;EQUE;T-$$9,00 FEE-REQUEST PROCESSED IN I 81JS14ESS DAYS <br /> *SIGNATURE OF APPLICANT <br /> FILE AORESS TH:5 SIDE EAD STAFF USE ONL.Y <br /> C <br /> PROGRAM ri-amawn;sEARCH <br /> L <br /> Jr <br /> j 5 E 'Vill <br /> ENVIRONMENTAL HEALTH DjVJSION FILES <br /> _tt;NVEqGR0&D TAKII(VST)CLEA UP SITE(LOP) 0 HOUSING ADATEMENT C3 SOLID WASTE FACILITY <br /> Ori'RR GLEANUPSITF(NON-LOP) 0 FOOD FACILITY C) SOLID WASTE%VHtCLE j <br /> h 0 UAJRY <br /> VNI)PAGS;UkO TANK(MONITORIN GIREMOVAL) C) Dog KENNEL a pKG 714EAYMENT PLANT <br /> ( M HAZAADCUS WASTE GENETtATUR 0 CHICKEN RANCH a ptjmpcR TRUCKiTArt=141 <br /> gtXED "ITTEDVACiLITY 93 MMUNOTEL a LANC UrE EASE S TES <br /> YOIL<zT5 <br /> 94TIATTOOPTIDY POIRCING 0 PCOLISPA, 0 oTHCR(PLEASE SPC W- <br /> 110WO <br /> P mCOtCAL WASTE FACILITY <br /> 1. List up to ton I adoross ec In !ho spaeo above. S01100t the typo(s)of files Ilion'the 1191 above chooking <br /> the appropriate box(c i). At least one fil <br /> to type MUST be ScIeCtOd0- <br /> rdicloted ab t ve. <br /> 2. END will notify the ap 7flcant I!any EKD files exist. An appointment for review will be confit ed <br /> approximately rive hu inose days but no later than ton-(10)days after receipt of applicationThe files <br /> will be held for a max mum of five businoss days for review. I Appointmur-ts should be scheeulod <br /> accordingly. <br /> 3. A Me th2t,lik aetiValy liting worked on by EldO stiff may not be inimcdIatelY.1vailible for re-ficw. A now <br /> application may best ibmitied whon the file Is av3ltsblv- I <br /> 4. Any file not returned n the same condition as released Will be reorganized by EHO Stan at ilio expense <br /> of the applic4ni. Fut t re rile ravlowc by the same appilcant may require a Sag.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confinnod with ENO star'.. <br /> 0. Applications rec-AVCd after 3;00 pm will be proccrsod the next business day. <br /> CONFIRMED APPOINTMEWDATE TIME <br /> UA-TE CONFIRMED PHONE rAx IN!TIAL' <br /> REVIEWED YES NO REVIEW DATE ------ <br /> LA Vj y/ NO <br />