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.1 '02 FR( 15:45 FAX 19259469968 ERMVVEST WCf�. 002 <br /> SAN J04 IN COUNTYPUBLiC HEALTH SERVICES F1°ttoaawnea <br /> V . E RONMENTAL HEALTH DIVISION \ <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 1 <br /> ! STOCicrON CA 95202 f _CCCIII <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION NOV <br /> nPPLicAHr C'�ts-r�� 0 1 2002 <br /> ADDRESS <br /> RUSINMIAOrNCY ENVIRONMENT HEALTH <br /> �i'�7�'7'�.....-� - -n <br /> �n`TF�EiO In l.rrcRVICES <br /> PHONE_ y'Y6 DFAL+SIMILE ,�^ J C�j/� � <br /> . �p <br /> TENTATIVE-APPOINTMENT DATE '�(Ji2 /�[� ?appllcatlon TIME /,�A. <br /> (Please Alva 7 l0 10 buslnou d - m <br /> aYs frwn dale of subml(lal) <br /> CHECK BOX TO EXPEDITE REQUEST-`;06.00 FEE-REQUEST PROCESBiNr DA <br /> SIGNATURE OF APPLICANT I <br /> 1ATE <br /> PILE ADDRESS THIS SIDE EH O STAFF US6 ONLY <br /> / tJA PROGRAM ELEMHNTS SEARCH <br /> 1 <br /> Ar <br /> V <br /> n <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILrtY <br /> OTHER CLEANUP SITE(NON•LOP) O GOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Y4 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O pKG TREATMENT PLANT <br /> O T(EHED PFRmJBOD TIED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRITGKlYARbICHEM TOILETS <br /> ❑ TADICA WAS PEIACILI ❑ POOUSPA ❑ LAND USE APPLICATION SrTES • <br /> ❑ MEDICAL WASTE FACILITY '% PUBLIC WATER,SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> �• List up to ten addresses In the spaoo above. Select the types)of files from the list above by chocking <br /> tho approprlato UOx(es). At (east one file type MUST be selected. Fax to (209) 464-01 h8 or mail to the <br /> address (ndi 'ated above <br /> 2. 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 ton (10) days after recelpt of application, The files <br /> will ba 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 ih the same conditlon as released will be reorganized by EHD staff at the expanse <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Appllcatibns received after 7:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE �. <br />