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ui/U6/ZUUZ MUA IMU NAA 916 5654356 R001/001url unr'on[ 119:4tl 4b91 <br /> ENVIRONI4=NTAL _LTH PAGE 91 <br /> " S-N JOAQUIN COUNTYPUBLIC HEALTH SERVICES s« too"eNegq <br /> ENVIRONMENTAL HEALTH DIVISION , <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> STOCi(TON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ':177f.�s.. r <br /> OUSINESSIAGENCY <br /> ADDRESS / - /.�.✓I/!/l4 l s- JJr <br /> PHONE <br /> EAcsIMaE �Y/_� S <br /> 0.TENTATIVE*AppoiNTMew DATE <br /> Me—give 7 t 1 TME <br /> I d apfINCS" <br /> � bmKtal) ' <br /> CHECK BOX TO EXPEDITE REQUEST- .00E QU ST OCES �1 PAYS <br /> SIGNN't'URE OF APPLICANT _. <br /> Cl DATE <br /> FILE ADDRESS - <br /> \ THIS SIDE CHD STAFF USE ONLY <br /> b PROGRAM ELEMENTS SEARCH <br /> Sz411 r, <br /> O <br /> V < < z <br /> vvv u! <br /> tiNq <br /> V a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Uf UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT <br /> D OTHER CLEANUP SITE(NON-LOP) tl SOLID WASTE FACILITYD FOOD FACILITY ❑ <br /> D UNDERGROUND TANK(MONITORINGIREMOVAL) v DOG KENNEL ❑ SOLID WASTE VEHICLE <br /> to IRY <br /> HAZARDOUS WASTE GENERATOR D CHICKEN RANCH . O pKG TREATMENT PLANT _ <br /> D TATTO PERMIT F(RCIN FACILITY O MOTELIHOTEL ' D PUMPER TRUCK/YAROICHEM TDILETS <br /> CI O MEDICAL <br /> WAS pE1RClI D POOIV8PA CI LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILT' , D PUBLIC WATCR SYSTEM o <br /> 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 approd cal d (es), At least ohe file type MAST be selected. Fax to 2D9 464-0138 or mall to the <br /> addross indicated above <br /> 2• EHD will notify the applicant if any EHD files exist An appointment for review will be Confirmed <br /> approXimately live 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 it:2vall4-bl¢, ' <br /> 4- Any file not returned in the same Condition as released will be reorganized by EHD Staff at the expense <br /> Of the applicant Future file reviews by the some applicant may require a$89,00 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 NO REM1EW DeTF ., .._ <br /> .IVI <br /> Post-!V Fax Note 7671 o^m7 r� p°,� ► <br /> Te Prom <br /> Ca10aPtMe- <br /> ph.# <br /> e-phone« •L C' <br /> ti k0 y 3 <br />