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U4/30/2003 09:42 FAX 209 9480621 <br /> ` ---'1 Q1002,003 <br /> OATS FACEIV _ EMU UNs nUma" <br /> "� "I' <br /> // '' OAN JOA'ClUIN COUNTYPUBLIC HEALTH SER=/ICES <br /> �_ a� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 3 0 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCOON CA 95202 I <br /> cNV!Far;!14'iu1 HEALTh - (zD9)46s3420 <br /> ,I.,t,?/c/ pvir,F; BLIC RECORDS RELEASE APPLICAI"I(�N _ <br /> APPLICANT %�� J"/w�'Le�GZ._ BUSINESS/AGENCY Ac' �Gt I 1 F ! <br /> ADDRESS .67-,D-5 >��-s� /✓JY�"1-!.P_ S-h ____ <br /> PHONE 671Y.0— /3c-fS FACSIMILE 9L/8—D6 =L <br /> TENTATIVE*APPOINTMENT DATE 5/�'/U 3 TIME <br /> (Please give 7 to 10 business days from date or application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-507.00 FEE—REQUEST PROCESSED IN 3 BUSINESS PAYS II Il <br /> SIGNATURE OF APPLICANT DATE DATE _ ` cti �!� <br /> FILE ADDRESS THIS 5101:EHD STAFF USE ONLY <br /> PROGRAM ELEMEWS SEARCH <br /> /876 C«,,,+r CI✓s TSI✓Z . i � — _ _ <br /> /P rC <br /> C6�,4--�y Crvc II/✓r z / <br /> OSI ov.� 'v cl" 81WL — <br /> R +, Clbg T3/✓d I <br /> l / r+ 1 C6✓n•ir CIo.L Zil✓ <br /> R92Z <br /> 575 CoVn+n C1.11. I IvL /-to � 61„6 131✓d <br /> 7'a� s COVr�•l-r Clt,bI✓L Ii) -= <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ..O'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 ;C 1LID WA.:iTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY B'S(lUO WASTE VEHICLE <br /> -O'GNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL D DAIR'i' <br /> O HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMPERTRUCK/YAROICHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING 0 POOLISPA O'LAND USE APPurA11ON SITES - <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 O'rHCR(PLEASE SPECIFY ABOVE) <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 Tile type MUST be selected. Fax to fz09) 464-0138 or mall to the <br /> address 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 lecxipt 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 EHD 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$07.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD 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 INITIA,1-8 _ <br /> REVIEWED YES NO REVIEW DATE <br />