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04/07/2003lI�iJ1 PAG <br /> E 01/01 <br /> � � 7 <br /> `� END LOG NUMeEft <br /> ANI� � = *UIN <br /> COUNTYPUBLIC HEALTH SEOICES <br /> APR 0 7 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> STOC}CfON CA 95202 <br /> ENVIRUNMENT HEALTH (209)468-3420 3 L <br /> PERMIT/SERVP(fi3LIC RECORDS RELEASE APPLICATION <br /> APPLICANT I \ BUSINESSIAGENCYj CQV C�Q�nu1/'LI�1d �O r•� <br /> ADDRESS 23?_A AQ U) d <br /> PHONE—642D4), Y107- 10610 FFACSIMILEQ ��"/` ��11 <br /> TENTATIVE'APPOINTMENTDATL'f 0a �� TIME __ �3 / <br /> (Pleas-give 7 to 10 business days from data !applic6tlon submiltal) • <br /> CHECK SOX TO EXPEDITE REQU T-$011.00 FEE-REQUEST ROCESSED IN 3 BUSINESS DA'rS ' <br /> SIGNATURE OF APPLICANT DATE D __ <br /> FILE ADDRESS .a <br /> v r Ue I • <br /> fo <br /> N C Le o _ <br /> ff If 1! ♦ , - Yeo K s, <br /> Qu UU LU <br /> D <br /> ENVIRONMENTAL HEALTH DIVISION FILE <br /> APR 10 2003 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FAGILJTY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENTPLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMA°'ER TRUCIWARD/CHEM TOILETS <br /> ❑ TATTOO/RODY FORCING ❑ POOLISPA ❑ LANO USE AP91LICATION SITUS <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ O"rHER(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. EHD 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 now <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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 doposit 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 clay. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ <br /> CH DD 14 01/Os,Na — <br />