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SAN JOA' IN COUNTYPUBLIC HEALTH SERIES <br /> EfI7IRONMENTAL HEALTH DIV ON �l(� <br /> 304 EAST WEBER AVENUE,THIRD L <br /> STOCK70N CA 95202 <br /> i (209) 468-3420 <br /> PUBLICiRECORDS RELEASE PPLICA ION <br /> APPLICANT/,M I R E �l9-->C I 1 Q[71j BUSINESSIAGENCY � Af'/11J <br /> ADDRESS 7l.ZC—S C.��f�/'i7,t/`z: �- �f/y C.� TDi, <br /> �� � J -PHONI � J J <br /> receov <br /> CTT lvo3-iG,d'�' i <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please.glve 7 to 10 business days from dato of application Submittal) <br /> FICNATURE <br /> T.5 -3 <br /> CHECK BOX TO EXPEDITE REQUEST-587.00F E-RE UEST PROCESSED IN 3 BUSINESS DAYS <br /> OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> 3�0 3 g I PROGRAM ELEMENTS SEARCH O <br /> MU 14 4 <br /> V <br /> 1 n <br /> ENVIRONMENTAL HEALTH DIVISION FILES `•Y <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE - <br /> UNDERGROUND TANK(MONRORINGIRFE OVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOUSPA ' 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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) 464-0138 or mail to the <br /> address indicated above <br /> 2. END will notify the applicant if any EHD files.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 held 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'lame condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future fill reviews by the same applicant may require a$87.00 deposit 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES iNO REVIEW DATE <br /> •�•• •• ... _... TOTAL P.01 <br />