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c 20'29dd -triol <br /> aa-1�—Gt71�1 na=:)IWi t•KLJM TO F.01 <br /> SAAB JOA�Ulbl COUNTYPU13LIC HEALTH SERVICES <br /> E VIRONME;NTAL HEALTH DIVISION <br /> AUG •] 3 2001 3 'EAST WEBER AVENUE,THIRD pLOOR <br /> STOCKT ON CA 95202 <br /> 'LI -" (209)468-3420 <br /> PUBLtC;REGORDS RELEASE APPi-ICATIUN <br /> - �.rm- ��r�near.wriwueur"r Ane..-. <br /> -APP.L(CAN7 o ILC'�2Se St15IAEE551A6FitCY 1�► 1 E3L�1`i eQ���'E--E t;ll. _, � �� <br /> AaDRESS - r�� .vtrc-c � �9ir� ail�c C,k `bJ L44)?) <br /> FACSINuLE \ �3C <br /> TENTATIVE*APPOINTMENT 04TE TIME <br /> (Pi¢asa$i4e 7-to 70 tsusin*4s Gays from data or apprmauon subsmittat) <br /> CMECK BOX TO FEXPE4lTE REQUEST-$$?.*00 FPS_RjEQV SY PROCFS11 3 UUSiNESS DAYS <br /> -SfGNATURE OF APPLICANT "�"'� � T DATE <br /> YYe�� <br /> F14E AOOPZSS' Y"M SIDEEHO STAFF USEONE <br /> PROGRAM ELEMENTS SEARCH <br /> M.l 'tic�ct+a a 3a <br /> cs� sA V `,lPREU <br /> 'tele 1-nt1xza tl z <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(US7)CLEANUP SITE(Lop) 0 HOUSING ABAMMENT C3 SOUD WASTE FACILITY <br /> UtHER CLZANUP SITE{NQztdr¢p) A FOOD FAcu ri y C SOt3D WASTE VEHICLE <br /> ORDERGRCUND TANK(MONrrORINGIREMbvAL) D DOG KENNEL a twfty <br /> G RA2An6ot)S wAsn Gcuw-QR Cl CHICKEN RANCH O PKG TREATMENT PLANT <br /> G TINEA PERtRi MD FACiLn`Y O NOTELJHOTEL 0 PUMPER TRUCK/YAR01CKE6i TOILETS <br /> C7 TATTOOMODY PEIRCiNG 0 PdOLASFA - ' " 0 LAND USS APPLICATION SITE$ <br /> G MEDICAL.WASTE FgOjj-iTY 0 PuEsLic WATER SYSTEM C3 OTHER(PLEASE SPEMPY ASOY9) <br /> 1 List up to ten.addresses in the space above. Select thetypes)Of files from the list above by checking <br /> the appropriate box(es). At{east one file type MUST be selected_ Fax to(209)4 fi Q136 or njoil to the <br /> ggfdross indicated above. <br /> 2. EHD will notify the 2ppiican%if arty FHP files exist, An appointment for review will be confirmed <br /> •approximitely five business days but no later than ten(10)days akar receipt of application. The files <br /> will be held for a maximum of Sve business day*for review. Appointments should be scheduled <br /> accordingly. <br /> 3. •A file that is actively being worked on by EH0 staff May not be immediately available for review. A new <br /> AppflGatiOn tray be submitted when the file is available. <br /> 4. Any file not roturned in the sape Condition a$released will be reorganized by END staff at the expense <br /> of the applicant. Future file ieAVIVs by the same applicant tray require a$87.00 deposit prior to review, <br /> 5. "TENTATIVE appointment dates must be confirmed with Emo staff', <br /> 6. Applications received after 3:00 pm will be processed the next business day." <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> e <br /> DATE CONFIRMED PHONE FAX INITIALS. <br /> Ra*lEwdp YES ND REVIEW DATE ' <br /> EX 00 it a <br /> TOTAL Fr01 <br /> nl PCRT qFJ" rnt; ::n7 i::i-TT-i y.:imjni-i 144 in, i'T rinH <br />