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TOGEOLOGICAL TECHNICS PAGE 01/01 <br /> 08/28/2002 <br /> ail 191 14PM FR""'02 14:57 2095224227 3 <br /> A SANOAf.ZU1N COUNTYpUDLIC HEALTH �rtViCE5 <br /> /.� ENVIRONMENTAL HEALTH DIVISION <br /> IJ) 304 EAST WEBER AVENUE,THIRD FLOOR n FC F IiV/ f <br /> 3TOCKTON CA 85202 ((1] 11 \/ (�fl)l 1 <br /> (209)4683420 <br /> \ <br /> P, 13IC RECORDS RELEASE APPLICATION AUG 2 9 2002 <br /> .t �" gusINFMAGENCY �N\/IRf1NM NTH ALT' <br /> APPLICANT <br /> ADDRESS CA c>l S 3 e� RW/SERVICES <br /> PHONE 5 '" �l.��l\ FACSIMILE c—� <br /> T@NTATIVE"APPO!NTMSNT DATE W"\\�, c, [ i w �b'&"DL <br /> (Please 6Byj've T tNo to�nx 4iys{rom,dale of a B�auon submittal) <br /> CHECK BOX TO DCPR�ORE IQU T•Se7.lfO KEE—RE1�Q ..T PRDCE>�ED I S BUSINESS DAYS p� <br /> SIGNATURE OF.APPLICANT \\�X DATE <br /> FIL,=ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> � 0 <br /> \ �s st yar <br /> i <br /> I ENVIRONME=NTAL HEALTH DIVISION FILES <br /> A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> It OTHER CLEANUP SITE(NON-LbP) ❑ FOOD FAgUTY O SOLID WASTE YEHICI 111 <br /> A UNDERGROUND TANK(MONIT RINOIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IV HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY i ❑ MOTrUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOO/BODY PEIRCING i ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY j ❑ PUBLIC WATER SYSTEM d OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addrbnses in the space above. Select tha typa(s)of files from the list above by checking <br /> the appropriate boit(es). At least one file type MAST be selected. Fax to QUM 484-0138 or mail t2 the <br /> address ind cate"bove, <br /> 2. EHD will notify the!applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately fivelbuslness days but no later than ten(10)days after receipt of application. The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is activejy being worked on by EHD staff may not be immediately available for review. A new <br /> application may b submitted when the file is available. <br /> 4. Any file not return¢d in the same condition as released will be reorganized by EMD 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 /> S. 'TENTATIVE appoihtment dates must be confirmed with EHO staff. <br /> S. Applications recolVed 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 /> CM al) 14 010 <br /> TOTAL P.01 <br />