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02/01/2002 16:04 2094671118 AGE S T(SCK-1 UN i-i,u` Ua/•j i <br /> EHp LOG NUMBER <br /> SAN .1(,,'�UIN COU TYl�UBLlC HEALTH S,—.,VICES <br /> S ENVIRONMENTAL HEALTH DIVISION <br /> 749304 EAST WE ER AVENUE,THIRD FLOOR <br /> 5T CKTON CA 95202 . 74? <br /> 209)468-3420 <br /> PUBLIC RECORE S RELEASE APPLICATION <br /> APPLICANT U12-aillI� AASi ESS/AGENCY <br /> ADDRESS /y J <br /> PHONEGfV FAGS Mt�l: <br /> TENTATIVE*APPOINTMENT DATE Q TIME D <br /> {Pleas Qive 7'to KO$- E(; <br /> s da s from t�of applicafEon subr.aittal} <br /> CHECK BOX TO EXPEDITE RE - 8. 0 EES D IN 3 sUStNESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDR9S3 <br /> • <br /> _S 013 <br /> Ole <br /> Wa <br /> 400 <br /> r.. <br /> I� a <br /> Wit)0 a4 <br /> or <br /> ENVIRONMENTAL HEALTH DIVISION FILES FEB —6 2002-. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HO SING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NEIN-LOP) 0 FO 0 FACILITY fl SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) CJ DO KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHI KEN RANCH o PKG TREATMENT PLANT <br /> TIERED PERMlrTEo FAGlLITY ❑ MO t:LlHOTEL rI PUMPER TRUCKIYARD/GHEM TOILETS <br /> TATTOOIBODY PEIRCING EO PO L/SPA C] LAND USE APPLICATION SITES <br /> C7 MEDICAL WASTE FAGILrrY ❑ PUBLIC WATER SYSTEM M OTHER{PLEASE=SPECIFY ABOvq <br /> !. 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 Iype MUST be selected. Fax to 209 464-0938 or mail to the <br /> 20CIress 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 HD staff may not be immediately available for review. A new <br /> application may be submitted when the fit is available. <br /> 4. Any file not returned In the same conditioi i as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th4 t same applicant may require a$78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be-c onfirmed with EHO staff. <br /> 6. 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 /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 OIMWOO <br />