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UZ/01/2002 111: 04 209467111fj AGE STOCK UN <br /> SAN J QUIN COU TYpUBLIC HEALTH END LOG <br /> 748 C�—1 <br /> 304 EAS W NRA HEALTH DIVISION.VIDES <br /> 304 EAST WE ER AVENUE,THIRD FLOOR it <br /> ST CKTON 95202 �� <br /> 209) 468-3-3 420 7 <br /> PUBLIC RECOR S RELEASE APPLICATION q �7 <br /> APPLICANT U2.Q. h, _D F/1�Ir/lll��Cn <br /> ADDRESS <br /> $i ESSlAGENCY <br /> �t <br /> PHONE A97J 7(O / �aQlij FACS MILE r1t <br /> TENTATIVE*APPOINTMENT DATE O TIME <br /> ,rJq/J (Pleas give 7 1I0 10 bk421n ss da s from to of application submdtaq <br /> f-� CHECK BOX TO EXPEDITE RE - 8.U0 EE- E S D IN 3 13VSINESS DAYS <br /> /SIGNATURE OF APPLICANT DATE <br /> FI EADDRESS <br /> 4100 <br /> wo <br /> � s <br /> ENVIRONMENT L HEALTH DIVISION FILES FEB -6 2002 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOI ISING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ F04 D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DCG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHI KEN RANCH tl PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY o MO EL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION STIES <br /> tl MEDICAL WASTE FACILITY ❑ PUE LIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space abo e. Select the type(s) of files from the )1st above by checking <br /> the appropriate box(es). At least one file Iype 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 hold for a maximum of five busine5 s 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 maybe submitted when the fil is available. <br /> 4, Any file not returned In the same conditio as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th same applicant may require a$78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be onfirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH o0 14 01/05100 <br />