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SAN WIN COUNTYPUBLIC HEALTH SERA <br />XIRONMENTAL. HEALTH DIVISION <br />/ 304 EA$TWEBERAVENUE, THIRD FLOOR <br />L (/ STOC KION CA 95202 <br />(209) 4"-3420 <br />PUBLIC RECORDS RELEASE APPLICATION _ <br />APP),IGAuT1 tr N E 6USIr1E5S1AGENCY 1S tJ oLa t6 <br />_ <br />PHONE �3y ��1 � FAC41MILE <br />V <br />V <br />TENTATIVFl APPOINTMENT DATE ever <br />{Plaa�sa ytve 7 io 70 t�ualruas days ham tlata ofnppftcat.ori submittal) � <br />GIIECK BOX TO "Fr_zOIT> P.EQVEST • 3 sT.O FE6 —REQUEST PROCE331ED Iii J BU.SSN"S DAY5 <br />OCT <br />� n <br />SIGNATURE OF APPUCA 4T DATE p I O�.T— J <br />I nis -1UL L"U b tArt VW QF4LY <br />PRQGR,U,1 I UNTEN7S SEARCtt <br />ENVIRONMENTAL. HEALTH DIVISION PILES <br />10 <br />r <br />UNDCROROUND TANS( (UST) CLLANUP 5fTE (XV? 0 HDWJNG ABATEMENT X SOLID ?IASTE FAC UTY <br />OTHER CLEANQP 91T9 (NON -LOP) ❑ FWV FACILITY O S4LIP WASTE VEiilCU <br />JK VNDERGROUNPTANK (NON1TORMCrMMOYAL� 0 ;,OG,K"NEL }SY.DARY <br />HAZARDOUS WASTE GCNCRATOR k;[,CH;CKRN RANCH D PKC# TREATMENTPLANT <br />13 7LERED PERMITTED FAC=I.ITY 0 N9T1!L/N0TEL O F'Ul PI:R TF(UCKlYARC)ICifi;M TOILETS <br />O 7ATTOOYR00Y PMCwc 0 POOL15P'A D LAN❑ USI:AYPLICATIOH SnS <br />Pl•MEDV AL WASTE FACILITY ❑ PMLIG WATEitSYSTEbi Ct OTHER (PLE-ASE $PF:CSFY AS0VE) <br />-1. List up to ten addresses In the space above. 8eloct the typo(s) of files front thy: fist ADOve by checking <br />th4 appropriate box(aa), At least one file type rAlJST he SaWotad. Fax tp ($49) 46j�0136gr mail o the <br />address Indicatecf,�fOClve. <br />2• EHD will notify the applicant if any EHQ files exist. An appointment for rcvlaw will ba confirmed <br />3ppr0x1n1atQly five busine" days but no later than ten (10) days after receipt of application, The files <br />will be hold for a maxirntrm of five IJusine$To days for review. Appgintmenta should be sabedulad <br />accorrtingly. <br />3. A file that is actively bein.$ vrorkod on by FHD Staff may not bn Immediately ayuilabie for review. A new <br />appllaatlon may be submitted when the 1110 Is avaliMe. <br />4• Any file not returned in the "Mo condition as rellp;$d Will ba reorganized tty EHD staff at thr; expense <br />of tho applicant. Future fila reviews by the same applicant may require x $97.00 deposit prior to rt view. <br />b. 'TENTATIVE appointment dues must be LOnfirMed with EHD staff. <br />6. Ap.liaatlons raroivad after 3:00 pm will be processed th4O nvxt business day, <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />RE1'11"YYED YES <br />TIME <br />PI-10NE FAX 1NMAIw5 <br />NO REVIEW DATIE <br />TI7RL F. 32 <br />