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v V0.(E4GLVCO LW 4h: tii)yu. 4a <br />SAN JOJWIN COUNTYPUBLIC HEALTH <br />EWIR40NMENTALHEALTH DIVISION <br />d' 304 EAST WEBER AVENUE, THIRD FLOOR /^ <br />$TOCKTONCA95202 <br />(209) 4083420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT �F— , ZZEnE2!f A;Z;4 �Gz BUSINE9S/AOENCY /? L �N�F" i7 �7P, <br />TTT—� _ <br />AD13RM 2T& dUrf <br />PHONE Z� /GFACSIMILE <br />TENTATIVE' APPOINMENT DATE TIME <br />(Please eivo 7�['0'_/`1/_Nb4sl�."/�/e-Ss daYs�it��q(7, eels of aa(/p-�p1l�uon sunmlIEA /�7 <br />ID cHEc;K PDX TO EXPEDITE REQUEST � S70.00 FEE- ItECuEsT PROCESSED �+ 3 BUSINESS DAYSUU1 2001 <br />SIGNATURE OF APPLICANT <br />DATE <br />O <br />ENVIRONMENTAL HEALTH DIVISION FILES OCT 22 2`1,01 <br />UNDERGROUND TANK (VST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT/� SCUD WASTE FACILI Y <br />OTHER CLEANUP SITE (NOWLOP) O FOOD FACa.T1Y ' SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITO4UNGWJEWVAL) ❑ DOG KENNEL VoTHER <br />oDAIRY <br />HAZARDOUS WASTE GENERATOR m CHICKEN RANCH PKG TREATMENT PLANT <br />4 TIERED PERMITTED FACTUTY 13MOTELMOTEL PUMPER TRUCKrYARDIGHEM TOILETS <br />L��7rATTOOIUQDT PEIWNG d POCIJ^SPA LAND USE APPUCATION SITES <br />/}p MEDICAL WASTE FACILITY E3 PUBLIC WATER SYSTEM (Pt rASE S'YECIFT ABOVE) <br />1. List up to ton addresses in the space above. Select the type(s) Of files fro Ist a v . checking <br />the appropriate box(es). At least one file type MUST be selected. Fax t RIXI) 464-0138 or it to the <br />address intllcated above. <br />2. EHD wl11 notify the applicant if any EHD files exist. An appointmentfor 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. Anyflle 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 578.00 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 />l REVIEWED YES NO REVIEW DATE <br />TOTAL I'.02 <br />