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yL1 I LE1i~IFLLDER EHaLOU NUMBER <br /> X4/02 MON 11:46 FAX 209 94, l <br /> 077. <br /> „eusevea <br /> SAN JOA,:JIN COUNTYPUBLIC HEALTH SER1rv%ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCaON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 43U51NESSIAGENCY O <br /> U JCA <br /> ADDRESS <br /> „ T - ! FACSIMILE <br /> PHONEO FEB 0 4 ZOOZ <br /> 71ME --`- <br /> TENTATIVE*APPOINThI>rNTE1ATE E'�VIRJf�.NIENf H[=A;I_TH <br /> (Please Dive 7 to 10 bu If from Dat <br /> cation submlttal) <br /> Al <br /> PI,Iz,4A IT/Srl 'ES <br /> ��..--++�� UES PRO DIN A.&MYS <br /> In CHECK BOX TO EXPEDITE REQUEST.$87 0 EE- L <br /> GATE <br /> SIGNATURE OF APPLICANT <br /> THIS SIDE EHD STAFF USE ONLY `` -- +1t✓ <br /> FILE ADDRESSPROGRAM ELEMENTS SEARCH ✓r �1 <br /> Z ' <br /> A wlL <br /> ENVIRONMENTAL,HEALTH DIViSIoN FILES 0 �- <br /> LID WASTE FACILITY V <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING AgATt NIENT 0- soLiD WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILII Y AIRY <br /> �'UNDERGROUND TANK(MoNifORINGIREMOVAL) ❑ DOG iCE1iNEL <br /> X <br /> ❑ CHICKEN RANCH PKG YI;EATMENT.PLANT <br /> RDOUS WASTE ❑ MOTEIlHOTEL ❑ PUMPERTRUCKIYARDICHEMTOILETS I-YA <br /> TIERED PERMITTED FACILITY 1 <br /> ❑ TATTOdl6ODY PEIRCING ❑-POOLlSPA LAND USE APPLICATION SITES ar 1140? <br /> ' <br /> 0 MEDICAL WASTE FACILITY <br /> PUSLIC WATER SYSTEM Q OTHER(PLEASE SP3=C[FY ASOVE) <br /> s of files from the list above by checking <br /> �. List up to ten addresses in the space above. Select the type( ) <br /> the appropriate box(es). At ieast one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> dre5s.indicated above• <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximateiy five business days but no later than ten(10) days after receipt of application. 'Che files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> j accordingly. <br /> 3. A file that is actively being worked on by EHO Staff may not be immediately available for review. A new <br /> { application may be-submitted when the file is available. <br /> i 4_ Any file not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$$7,00 deposit pylar 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 /> 1TE CONFIRMED PHONE FAX INITIALS - - � <br /> 'WED YES No REVIEW DATE <br /> aa�orma <br />