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`FR'Ij( ,TP Environmental PHONE NO. : 209 369 4228 17. 2003 11:05RM P2 <br /> SAN JCOUIN COUNTYPU13LIC HEALTH SA ICES eno"00 Num"R <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 1 1 2003 304 EAST WEBER AVENUE,THIRD PLOOR <br /> STOCATON CA 95202 <br /> I=NVIRCf�'MEiW HEALTH (%109)468-3420 <br /> °Fr3rnnisEF�VIr�Fr; PUBLIC RECORD, RELEASE APPLICATION <br /> APPLICANT �j ( Q /{ BUST/NI.SSIAGENCY <br /> ADDRESS Y•-lb 1shD i;�^.2 LOC7 .-/a_Q_"!n.,G:z�.3�6L_ .._ ,�� <br /> PHONE <br /> �. FACSRtILE�T.G9),3Gr - T7.Z� --d '` <br /> TENTATIVE*APPOINTMENT DATE �IILp/OJ q <br /> TIME <br /> (Please give 7 to 10 buslno:•s aysq frpm date of appllcatlon suUmiti W) <br /> CHECK BOX TO EXPEDITE REQUEST e,paFEE- OIlEs7 PROCESSED IN 3 BUSINESS DAN", <br /> SIGNATURE OF APPLICANT DA,fle�g <br /> FILE ADDRESS THI:i:IPE EE atO STAFF USE ONLY A�'J•" <br /> PROGRAM ELEMENT::SEARCH ` <br /> er'I0 Pro 9y3(o Sdvc X01 i �\/y�/-al <br /> V 10 <br /> 1I <br /> L,0. <br /> �' v J xK - <br /> 00 - <br /> o w. <br /> e <br /> � r tea - � � ,®• <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ 14OLISING ABATEMENT El ;OUr WASTE FACILITY <br /> A'OTHER.CLEANUP SITE(NON-LOP) 0 FOOD FACILITY EI ;;OLEIC WASTE VI?HICLI- <br /> 8f UNDERGROUND TANK(MONITORING/REMOVAL) 0 004 KENNEL ❑ LAIRV <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHI;KEN RANCH Cl F'KG IKEA-miefr PLANT <br /> ❑ TIERED PERmn-rro FAciu TY ❑ MOTE OTEL C) PUMP IcR TRl1CWYARC/CHEM TOI.ETS <br /> ❑ TATTOOIBODY PEIRCWG O POCILISPA CI LANOUSEAPPLICATIONSITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUE LIC WATER SYSTEM CI OTHE.1(PLEASE SPECIFY ASOVh) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files fro n the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected.-Fax to 109 . 1138 or mall to the <br /> address indicated above. __� 11 <br /> 2. EHD will notify the applicant if any EFID files exist. An appointment:for review will be confirmed <br /> approximately five business days but no later than ten(10)days after recr:lpt Oe application. The files <br /> will be held for a maximum of five bu siner s days for review. Appoirnhnews should be scheduled <br /> accordingly, <br /> 3. A file that Is actively being worked on by E ID staff may not be immediately available for review. 'Anew <br /> application may be submitted when the fits 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 th(t same applicant may require a !;89.00 deposit:prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> �. Applications received after 3:00 pm will bo processed the next business ti;Fy. <br /> CONFIRMED APPOINTMENT DATE TIME _ <br /> DATE CONFIRMED PHONE FAX itari AI_S <br /> REVIEWED_ YES NO REVIEW DATE <br />