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o _ <br /> -)8/2002 13:29 20946711 AGE STOCKTVN BIR �Li t11 <br /> .dCE1VE0 EHD LOG NUMBER <br /> .' Y- 7 <br /> JO QUIN COU TYPUBLIC HEALTH S t VICES <br /> ENVIRONME TAL HEALTH DIVISION <br /> 304 EAST WE/B� R AVENUE,THIRD E$TO KION CA 95202( 09)abs-3420 <br /> PUBLIC RECORD RELEASE APPLICATION <br /> III)IIIIJ <br /> APPLICANT <br /> l 6�`V 1 to BUSIN SS/AGI"NGY d® 1 <br /> ADDRESS <br /> PMO - a FACS! lILE r�/ <br /> TIME r en:�._ <br /> ENTATIVE'APPOINTMENT DATE <br /> (Pleas®give 7 to 10 basins s days from date of application submittal) ad AR40M <br /> y� <br /> CHECK BOX TO <br /> EXPEDITE REQUEST.$7 0 FEE—REQ JEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE $ a� <br /> FI ADDRESS <br /> SID <br /> ✓ AW ' <br /> ENVIRONMENT L HEALTH DIVISION FILES JAN 31 <br /> 2002 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HO SING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) © FO D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DO KENNEL, 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR Cl CHI KEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MO L/HOTEL 0 PUMPER TRUCKlYARDICHEM•TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 P L/SPA ' ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUI ILIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space abo e. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file pe MUST be selected. Fax to (209J 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fi es exist. An appointment for review will be confirmed <br /> approximately five business days but no ater than ten(10)days after receipt of application. The files <br /> will be held.far a maximum of five busine s days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is.actively being-worked on by HD staff may not be immediately available for review. A new <br /> application may be submitted when the fi a is available. <br /> 4. Any file not returned In the same conditio i as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th same applicant may require a$78.00 deposit prior to review. <br /> 5. *'TENTATIVE appointment dates must be- onfirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> CONFIRMED*APPOINTMENT DATE TIME -----.- <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01/05/00 <br /> e <br />