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FROM : NOH Envirormmtai PHONE NO. : 209 369 4228 Dec. 23 2002 12:25PM P4 <br />,SAN JLTAQUIN COUNTYPUBLICHEALTH SERVICES FJW Lw NUMUPA <br />_e 'ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, THIRD FLOOR <br />2 3 2002SEC STOCKTgN CA 932p2(209) 468-3420 fD qq <br />1111.` <br />F'0I'PU8LIC RECORDS RELEASE APPLICAMN <br />;: „ <br />-IN 3 <br />APPLICANT - -L IW61J([/.7 / BUSINESSIAgGENCY�(nry L-y�„�y,� <br />ADDRESS � . f-{,_.57fj>1Q Lri_f- � ' C4 5041 D <br />PHONE _1 205) 3%7 -3701 , FACSIMILE 22Fr 30,.� <br />TENTATIVE' APPOINTMENT PATE -q. 206 <br />Please give 7 TIME -'alai <br />( 9 to ie business days from dale of ePPlicatlen Submittal) / t <br />CHECK BOX TO EXPEDITE REQUEST, $89�E- RE ES PROCESSED IN 3 BUSINESS DAYS u n i %u(] <br />SIGNATURE OF APPLICANT 4�{ j DATE / Z3 - <br />,O <br />W <br />M <br />I✓GVI t _TC JFIC�L. Al�%4 Yj <br />ENVIRONMENTAL HEALTH DIVISION FILES _T r <br />tf UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />B' OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGMEMOVAL) <br />❑ FOOD FACILITY <br />III DOG KENNEL <br />❑ SOLID WASTE VEHICLE <br />1� HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACi1_I7Y <br />❑ TATTOO/BODY PEIRCING <br />❑ MOTELMOTEL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ MEDICAL WASTE FACWTY <br />❑ POOLSPA <br />❑ PUBLIC WATER SYSTEM <br />❑ LAND USE APPLICATION Srrr=S <br />mi- OTHER (PLEASE SPECIFY A80vc) <br />1. List up to ten addresses in the space above. Select the types) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 4G4-0138 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 new <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 $89.00 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, <br />DATE CONFIRMED <br />REVIEWED YES NO <br />rtllydt <br />PHONE FAX INITIALS <br />