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Jw'fL NECEClEU S w LOG 14V a 1 <br /> :77I` �,i ) SAN SL tJIN COtfNTYPUBLIC HEALTH S .:VICES <br /> SPS ENVIRONMENTAL HEALTH DIVISION <br /> NO 2 4 2001 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SYOCKTON 95202 <br /> (209)468-3-3 424 <br /> EPlVIr'uP.��IEi� ALiH PUBLIC RECORDS RELEASE APPLICATION <br /> APPJ.JCANT Ma.v'i lt-14 - 4%&4 L--¢-.S RUSJNESSfAGENCY Cav%-vLo, 't"(n �2cttyi..o In giaS .�vic. <br /> ADDRESSISS Fro-nk Wa_ i- GiNcI,Q 5w..: i-•a. T. , Si-acted-o�-. , CA ` S 2-n <br /> T �+ <br /> PHONE 2-01 - 2'3 } - 05'l t3 FAcsiu LE 2-0'1 - 2 3"t - O 1�%$ • <br /> TENTATIVE*APPoINTmENTDATE &(3p1p) TIME 8 <br /> ease a — I <br /> (Pl9NO 7 to 10 buslnf2-Oe"days from date of applkation submRtal) <br /> CHECK BOX TO EXPIW[TE REQUEST-187.00 FEE-REQUEST PR CESS W 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE L5' $ a 2e-cr--f <br /> FILE AOORESs THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> sE Wuk1 WV <br /> 5'r»�ic �on <br /> \IJ 1813 _— <br /> b f A _may_ <br /> // ENVIRONMENTAL HEALTH DIVISION FILES <br /> tom,UNDERGROUND TANK(UST)CLEANUP Sn'E(LOP) II HOUSING ABATEMFM Q SOLID WASTE FACii.17Y <br /> HER CLEANUP SITE(NONILOP) Q FOOD FACILITY L7 SOUR WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Ia'HAZARDOUS WASTE GENERATOR II CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PEM HIED FAMITY 0 MOTFA/HOTEL ❑ PUMPER IfRUCMARDICHEM TOILETS <br /> II,TATYGOIBODY PEMCING O POOLISPA ❑ DINE USE APPLICATION SITES <br /> f7 MEDICAL WASTE FACILITY ❑ PUBUC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY A00VE) <br /> 1. List up to ten addresses in 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) 4644-0138 or mall to the <br /> ad(jr ss Indicated above. <br /> 2. EHD will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ton(10) days after receipt of application. The files <br /> will be held for a maArnum of hive business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHL)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$87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EW staff. <br /> 8. 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 />