Laserfiche WebLink
Ub/14/ZtlOtl 1J:4! ZU7l b! lib <br /> HVG b WKI U11 <br /> I"HUG Gl/GL <br /> SAN QUIN COUNTYPUBLIC HEALTH r '2VICES <br /> ENVIRONMENTAL HEALTH DIVISIV rn <br /> 304 EAST WEBER AVENUE,THIRD FLOOR `I <br /> �V ) S7DCKTON CA 95202 Q w <br /> U(209) 468-3420 j�j o =j <br /> ��AA PUBLIC RECORDS RELEAlS�,E APPLICATION fit �yJW <br /> APPLICAN (.d �Ip J 1 BUSINESSIAGENCY /L.� 0012ACe 6I AimV4&0627 <br /> ADDRESS -7--77DVS W�ISOCD <br /> C 'f7U Chlt//,, SaZJVS� z CCW <br /> PHONE OTO _ D FACSIMILE pt �` '7 — /" , W0- <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> t^1 (Please glue 7 to 10 business days from date of application submittal) <br /> L-I CHECK BOX TO EXPEDrrE REQUES .e0 FEE-REQUEdPESEDIN3 eUSINESS DAYS' DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESSj,L 6�CLQ O <br /> ff � O <br /> o <br /> 14 <br /> ENVIRONMENTAL.HEALTH DIVISION 40. 16 2000 JUN 1 4 Mo <br /> IITUNDERGROUN13 TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID wASTE FACILITY r <br /> ❑ FOOD FACILITY El $OLIO WASTE VEHI� IRLJ)��''ACI'`I I I' <br /> OTHER CLEANUP SITE(NON-LOP) 6 DAIRY <br /> UNDERGROUND UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL <br /> El CHICKEN RANCH ❑ PKG TREATMENT PLA <br /> HAZARDOUS WASTE GENERATOR IM MOTEUHOTEL ❑ PUMPER TRUCK/VAROICHEM TOILETS <br /> TIERED PERMTED FACILITY ❑ POOUSPA EILAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING ❑ pUeLIC WATER SYSTEM 17 OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses ill 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. ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. An app <br /> approximately five business days but no later than tan(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 /> ill be reorganized by EHD staff at the expense <br /> 4• Any file not returned in the same condition as released w <br /> of the applicant. Future file reviews by the same applicant may require a $78.OD deposit prior to review. <br /> y, 'TENTATIVEat ns receivointment dates must ed after 3:00 pm wlle <br /> e Confirmed with EHO staff. <br /> 6. AAP be processed yd the next business da <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 1� ailoSYo <br />