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08APR.23.20043: 9:15Am64a1nPEX ENVIROTECH.INC. <br /> „�11.rr,Hricrveo <br /> N0.588 P.2' I <br /> -ji SAN .� St <br /> QUIN COUNTYPUBLIC HEALTH RVICES uo�xNunmax <br /> ENVIRONMENTAL HEALTH DIVISION I <br /> APR 2 3 2004 � 304 EAST WEBER AVENUE,THIRD FLOOR <br /> S70CKTpN CAQ' <br /> (209) 468342020 /V� I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT jeA1yliL�cr WOr-�5If, 9US(NE8S/AGENCY_ oe2' elwty-z ccG1 r � <br /> ADDRESS Ry V-f �eLS L2)� D[pl' I`-lu C,,r' C.A ' lS&-70 it <br /> PHONE glro gS( - O (7y- FACSIMILE c( l�O - �6'� I- Dt-7 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days tram date of application submittal) <br /> g3,00 <br /> CHECK BOX TO E(PEDITE REQU ;YS g0 FEE- REQUEST PROCESSED IN a 6USINESS DAYS UP• 1��I <br /> SIGNATURE OF APPLICANT DATE aS O <br /> FIL 15 ADnRESS THIS SIDE FHO STAFF USE ONLY (/ <br /> PROGRAM ELEMENTS SEARCH <br /> 4 5 E Il+k 5 f Tr usr <br /> 0 YI. 21J4caw\ <br /> �k5 E. D <br /> 44L us \ <br /> 00 rr +hca 0 C �sT <br /> 5 E Il"h r usT H�3\4 <br /> 5 1 `✓F ✓ c usT' <br /> E <br /> "r, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 'b UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING Ae ATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ❑ UNOERCROVNO YANK(MONITORINGIREMOVALI ❑ DOG KENNEL O DAIRY <br /> .D--HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERWFT-CFD FACILITY 0 MOTQIHOTEL ❑ PUMPER TRUCKIYAROICHEM TOIW . <br /> ❑ TATTOOIGODY PEIRCING ❑ POOLISPA t7 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ADOVE <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by check <br /> the appropriate 130x(es). At least one file type MUST be selected_ Fax to 209 464.0138 of mail to t! <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 fil <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 bleing worked on by EHD staff may not be immediately available for review. A w <br /> application may be submitted when the fife Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the exp( e <br /> of the applicant. Future file reviews by the same applicant may require a 889.00 deposit prior to M W. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:0U pm will be processed the next business ,. <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES : No I mrw DATE -- T <br />