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1 <br /> „ <br /> N �b@U1N COUNTYPUBLIC HEALTH 5 GES _. <br /> ENVIRONMENTAL.HEALTH DIVISION - R30 O <br /> APR 0 7 2003 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> sTOC)CTON CA 95202 <br /> ENVIRONME( (209)4S&3420 <br /> j �IECORDS RELEASE APPLICATION <br /> �L / <br /> APPLICANT ak, C(3 <br /> --6 , L aU8INE55lIAG/ENCY L.re/J 49,�OIAYJo�1 <br /> ,�{ ADDRESS _'�/ <br /> �� VHONE S10_ q/b ' �.7�'^ FACSIMILE 7 �b�ff11 <br /> TENTAT LVE'APF DINT(PMI!E!NHT 9D1AYT!E7 fo'10 6usinaa !4d �lem tlaf!0f apPIICTIItM1�En su/b /) <br /> Qr®nu lid t�["*S <br /> �iv55 <br /> �'IpI/f5 fE !q!/�+'f <br /> zel%w ./- <br /> I—I CHECK BOX 70 EY.PItD(II;REOUE8T-1(/89.00 reEE)-RRrQUESTPROCESSMIN34t1SWlS3 DAYS if 5nf*��iN iS �/bfR�![a(4,E5 <br /> tSIGNATUREOIt.APPUCAAT '� I/C�l DATE3 BID SH NL <br /> I O <br /> F'LE-no RESa PROGRAM£LEUR9Te SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> •� HOuSING ABATEMENT O SOLID WASTE FACILRY i <br /> OUNDERGROUND TANK N3TI CLEANUP SITE(LOP) 0 FOOD FACILrrY 0 SOLID WASTE VEHICLE i <br /> 0 OTHER CLEANUP SIM(HCN-LCP) O WQ KCNNEL O DAIRY <br /> 0 UNDERGROUND TANK(MONn'CRINGIReMOVAL) CHICKEN RANCF: 0 PKG TREATMENT PLANT <br /> 13 0 HAZAADOUS WASTG CEN9F1ATDR 0 pUupERTpUCKfYARDXI1EM s N TOILETS <br /> •�i 0 MOTFI/ROTEL 0p U8E APFUCI!TON SITES <br /> O TIERED IBODY ED FACILriY 0 p00L/5P� <br /> ❑ TATTOO/BODY P882CINO G O OT1iER(PLEA88 SPECIFY MOVE) <br /> O MEDICAL WASTL PACILITY " <br /> �. <br /> List up <br /> to tan addrEsse.in the spaCe above. $elect the types)of files from the list above$mel I to theg <br /> the appropriate[sor.(es)• At feast one file type MUST'be selected. F <br /> addruaD•I Ica !&.{Ibove• <br /> 2. EKE)I x41n t¢I notify <br /> tjjq IppliCant If any EHD flde business days but nolister than tles exist. on(10)days altar recelpt f application. The files <br /> pp y' ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3, A flle that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> appliclltion may be submitted when the fila is available. <br /> 4 Any fila not ratumed in the same condition as rolaasad will be reorganized by EHD staff <br /> osi at the expense <br /> Df the appllcanLp Futuro <br /> file rOVI must by <br /> the o a nfisame;& wtth EHD staff.require a$H9.00 deposit prior to review. <br /> S, *TENTATIVE ap, will be processed the next business day. <br /> s. APpl;wtions rQce N'ed after S:DD Pm <br /> TIME <br /> CONFIRMED APPOINTMENT DATE <br /> j <br /> PHONE FAX INITIALS <br /> I DATE CANF1RUE D <br /> REVIEWED <br /> YES NO MIEW DATE <br /> pyo ue�ew <br /> WUS0:01 :=00Z 2_0 •�dy 'ON Xt)d WONJ <br />