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! ¢nTERECEIVED <br /> 11F SAN J WIN COUNTYPUBLIC HEALTI <br />�. Ef+�VIRONMENTAL HEALTH DIVISION 9 <br /> y 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> J sTc]CKToN CA 95202 <br /> (209) "B-5420 <br /> Li ECORDS RELEASE APPLICATION <br /> APPLICANT B1�S1t11 SSfAGl±NGY <br /> PHONi LJ FACS1161ILE f <br /> TIME <br /> TE1NTAYIVE'APPQUTr1111EI4T C1ATH. Y+s �"` li ation s�ubmivai) <br /> {PlcuSa&Iva 7 to 10 Iouslhasa ys fra-dais at app <br /> Ei <br /> CHECK BOX TO EXPERSYE'REQUE - Ta.00 FEE-REGiUE^T ROC <br /> E53EO IN BUSINESS DAYS <br /> IGNATURF OF APPLICANT DATE <br /> FILEAL1L1SS <br /> TIP /V <br /> r r <br /> L ti 3316 Al/ <br /> 1 <br /> r .�. ►' <br /> DS' iI 3s:a c. 1.p <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1UNDERGROUND TANK LUST)CLEANUP SI FE(LOP) HOUSING ABATEMENT Q SOLID WAS7rE FACILITY <br /> OTHER CLEANUP SM(NON-LOP) D FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 11 DAIRY <br /> HAZAIto0U5 WASTE 6ENERATOR ❑ CHICKEN RANCH 0 PKG TRRATMENT PLANT <br /> 11ERED PERMnTER FACILITY La MO7EL1H0TEL. 0 PUMPER TRIICWYAR ICFIEM-TOILE:TS. <br /> 0 TAT roomocfy FORCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEGDICAL WASTE FACILITY 13 PUBLIC WATER SYSTEM 0 QTHER(PLEASE SPECIFY AJUNE) <br /> 4 <br /> I- List up to ten addresses in the space above. Select the type(s) of flies from the list alcove by checking <br /> the appropriate box(es). At least one file typo MUST be selected. Fax to 209 464-0134 or rngll to thy- <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 recelpt of application. The tiles <br /> will be hold for a maximum of five business days for.review. Appointments should be scheduled , <br /> accordingly. <br /> 3. A fila that is actively being wanted on by EHD staff may not ba Immediately available-for review. A new <br /> application maybe submitted when the file is available. <br /> d. Any fila 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$78.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be rOnfirrmed with EHD staff. <br /> 6_ " Applications received after 3:00 pm will be processed the next busin6ss day. <br /> i E <br /> A <br /> CONFIRMED APPOINTMENT DATE~ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> .1 • <br />