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HUE 09 05 08: 48a COMM BANKS OF NORTHERN CAI 2088392180 <br /> ror ver tnt7� bti:44 2094F--1433 P. 1 <br /> EHE PAGE 01 <br /> SAN JOAQUIN COUNTY U _..___..._..__ <br /> eNVIRQRMENTAL HEAL T N DEPARTMENT <br /> 304 EAST VVEg <br /> ER AVENUE,UI=,THIRD FLOOR <br /> KTON CA 2520,E(09)468-3420 <br /> 4 <br /> PUBLIC RECORDS RELEASE APPLICATI <br /> APPLICANT �N <br /> OUSINE <br /> SSIRGI:NCY f <br /> ADDRESS ��"�� � �, O�' <br /> PHONE <br /> FACSIMILE <br /> TA` Yt• .�F IYITd�eNI <br /> {Pl 7 t S d s{ rn TIAiI <br /> lV! dt of AD[� s alb <br /> C E B O ED REO <br /> .Ue EE E <br /> SIGNATURE OF APPLICANT su i+lErssa>a��.� <br /> DATE <br /> FILE AADRE THIS SIDE r;HD STAFF usE ONLY <br /> L ed M PROGRAM ELEMENTS SEARCH <br /> 1 <br /> �` ENVIRONMENTAL HEALTH DIVISION hLlE;S ) <br /> ?C!1 <br /> UNDERGROUND TANK(US7)CLEANUP 517E{LDP) Q HptJSINC;ABATf <br /> CI OTHER CLEANUP srm(NON•LOP) F04D FADILITY EMENT SOLID WASTE FACILITY <br /> O UNDERGROUND TAN[{(MONITDRTNGlREMOVAL) ❑ DOG KENNEL j SOLID WASTE VEHICLE <br /> 27 HAZARDOUS WASTE GENERATOR DAIRY <br /> TIERED PERMITTED FACILITY M CHICKEN RANCH � ❑ PKG TREATMENT PLANT <br /> E3 TATTCOMOpY PEIRCING t7 MOTELMOTEL. 0 PUMPER TRUCKIYARDICHEM TOILE'T'S <br /> 0 MEDICALWASTE FACILITY ❑ POWSPA 0 LAND USE APPLICATION SITES <br /> CI OTHER(PLLASE SPECIFY) i <br /> 1• List up to ten addresses In the space above. Select the type(s)of riles from the list above by Checking <br /> the appropriate box(es). At least one file tip®MUST be selected: Fax to 209 464-093$or mail to the <br /> address lraEed above. <br /> 2. END wiind <br /> ll 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)bays after receipt of application, The files <br /> will be held for a maximum of five business days for review. AppointmentsstTeuW 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 neva <br /> application may be submitted when this file is available_ I <br /> a• Any file not returned in the same condition as released will be r�ealrganixed by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> S. 'TENTATIVE appointment[fates must be confirmed with EHO staff. <br /> s• Applications received after 3:00 pm will be processed the next business day. <br /> CON .IRME�A PiotTt rnr cA4 <br /> Ti t , <br /> DATE OIRNIED. I <br /> P 4NE- . F <br /> REVtEWE t. <br /> Em-i azaoa NO IEW.Q T <br /> ]nvmo� <br /> 4C --3((.5� <br /> i <br /> I <br />