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Mar. 5. 2002 5:07PM CONDOR EARTH TECHNOLOGIES - No -8600 P.4/4 <br />�ntHD <br />HumaER 03 <br />SAID OAQU}N COi1NTYp'UBLtC HEA LT C <br />ENVIRONMENTAL HEALTH DMMILj <br />r 304 EAST WEBER AVENUE, THIRD FL <br />STOCK CA 95202 <br />02 MAR --5 Fm 4: O - (209) 468-3420 <br />63LIC RECORDS RELEASEE APPLICATION <br />APPLICANT �,4E' <br />.,,,, ,� At` <br />:�,-n,-,- BUSINESS/AGENCY i ' e- <br />IL <br />ADDRESS <br />PHONE r�s� _ FACSIMILE �-f- <br />TENTATIVE* APPOINTMENT DATE _ `- <br />(Pt4asa live Ito <br />�10 bul <br />CrIEcK nDx To EXPEDITE REQUEST. $1; .00" FSE' <br />SIGNATURE OF AF'PLICIANT <br />6 <br />U <br />l 2w <br />TIME -- <br />Is dais of appii�a n► sub <br />R 3 D I1S AYS <br />THIS SIDE EHD STAFF USE ONO <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />IPI'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) o Hous=ABATEMENT e5dLio wAm I;AcILITY <br />❑ OTHER CLEANUP SITE (AVON -LOP) ❑ FOOD FACILITY❑SOLID WASTE VEHICLE <br />t -UNDERGROUND TANK (MONITORINGtREMOVAL) ❑ DOG KENNEI. HAIRY fJ <br />(Er -HAZARDOUS WASTE GENERATOR CHICKEN RANCH © PKG TRP.ATMENT PLANT <br />`TIERED PERMITTED FACiLIrY b MOTEIJHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br />Q TATTOO/BQDY PEIRCING Cl 1`1000SPA " ' ❑ LAND USE APPLICATION SffES <br />M,'MEDICAL WASTE FACILITY 17 PUBLIC WATER SYSTEM 10 OTHER (PLEASE SPECIFY ABOVE) <br />V'/' <br />k- <br />........... &-=-- - <br />ENVIRONMENTAL <br />ik- <br />1. List up to ten addresses in the space above. 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 209 464-013 ail to the <br />address indicated above. <br />EHD will notify the applicant if any EHD flies 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 hold 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 />applications may be submitted when the file is available. <br />it. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br />of the applicant_ Future ffie'revlews by the same applicant may require a $87.00 deposit prior to review - <br />5 - <br />eview.;i- `TENTATIVE appointment dates must be- confirmed with EHD staff. <br />la. Applications received after 3:00 pm will be processed the next business day, <br />tfONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />