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Feb - 13 , 2003 2 : 02PM CO, EARTH TECHNOLOGIES No - 2817 P 1/1 <br /> DATE RE=VE (r-��,-1��-'i;' -'��. HMA LOG NUMBER <br /> JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> F E'13 1 L003 304 EAST WEBER AVENUE, THiRD FLOOR <br /> STOCK-FON CA 95202 115 <br /> :� `vr1;it 'i"i'!1 :(v l I iCrl�l Fl (209) 468-3420 <br /> 1T;SEWV'iCPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT � _HUsINESS1AG�lCy <br /> ADDRESS ,�V S _ <br /> PHONE -- <br /> FACSIMILE <br /> o��-��� � + <br /> T>~NTATIVE APPOINTMENT RATE a`f Time <br /> (Pleane give 7 to 10 business days Mom date of application subtt Maf) <br /> Uni• �CHECI'(sp)('I'q pCPEDrrE REQUEST-X87.00 Fhb--REQUEST PROCESSED3 BUINESS DAYS IN S <br /> SiGNATURE OF APPLICANT -1pt. iJATE <br /> FiLE ADDRESS THIS sl>o EHD STAR US-ONLY <br /> d hp U$r F-LEME141M SEARCH <br /> wn gay-7 Wod Cdr MA f-CA no ✓Sr e T <br /> 1 itv <br /> L- r ""e `N <br /> ';L0 96 5 . an-f- eae.. Rd �:� t D cT ✓ __ <br /> . a <br /> S Se. �. n0 S� _ <br /> 700 y% <br /> s • 6CDr. no u b n <br /> 00 P Dr io ✓ ✓ _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SIT>=(LOP) 0 HOUSING A13ATEWNT SOLID WASTE r-'WILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORIN"EMOVAL) ❑ DOG KENNEL PKG T <br /> HAZARDOUS WASTE GENERATOR �CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ HAZ T)PERM( AST FACILITY ❑ mOTEIHOTEL ❑ PUMpM TRUCK YARD/CHEM TOILE1Z <br /> 0 TIERED E"IODY PED FACT ❑ POOL/SPA W LAND USE APPLICATION srrEs <br /> ❑ MEDICAL WASTE IRFACILITYNG ❑ PU8UC WATER SYSTEM ❑ OTHER(pLEA�SE SPECIFY AbavE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the Ilscj:jbove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209 4t'r4F��138 Qrl12il to the <br /> addres$ indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will ib<I confirmed <br /> approximately five business days but no later than ten (10) days afterreceipt of apl�licatloii. The fi1+!s <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 /> 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 EHLI sRaff at the expotlse <br /> of the applicant. Future file reviews by the same applicant may require a $137.00 doloosit 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 /> CONFIRiII[ED APPOINTMENT DATE TiME _�� <br />