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Aub - 14. 20034: 02PM CON' EARTH TECHNOLOGIES No 4644 P . I/I �ly� <br /> 0,A 7E REG_,Y6b r� <br /> Eri0�oG Numa6tt <br /> c NQ SAN JOAQUIN 0. QUN-TdYAU�iMCl HEALTH SERVICES <br /> '';`,('\' ENVIRQNM8NTAf?'4 ALTH DIVISION <br /> 304 QQ� B � Rn FLOOR <br /> WEBER <br /> dA �o <br /> \4 P� 4� . (209) 468-3420 <br /> 03 AU`' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIC;.NT 1QGL _8U51NESSIAGE'JCY i <br /> ADDRESS <br /> PHONE_ FACSIMILE <br /> T1rNTATIVE*APPOINTMENT OAT7E l 4 F� �� (�S I �jj TIME <br /> (Please give 7 to 10 business ys from data of appilcation 5ul3ndttal) <br /> • <br /> CHECK BOX TO EXPEDITE REQUEST-g87.00 FEE-Rt~QUES7 PROC>:55LD 1N 3[jUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE 03 <br /> FILE ADDRESS THIS SIDE EHD STAFF USF,ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> a�11 S5' N. eA,t rPa <br /> D/ Nbs / D o� <br /> R2,5 <br /> d <br /> � y Y <br /> r,g F7 w <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0'UNr)ERGROUND TANK(USIA CLEANUP 5171-6(LOP) d HOUSING ABATEMENT 1?7-SOLID WASTE FACILITY <br /> BOTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY 4ET_SOUD WASTE VEHICLE <br /> CR-UNDERGROUND TANK(MONITORINGJREMOVAI,) ❑ j ()G KLNj4EL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR O'CHICKEN RANCH Ca PKG TREATMENT PLANT <br /> a-TIER617 PERMITTED FACILITY L7 MoTEL/HoTEL ❑ PUMPER TRUCKJYARDICHEM TOILE-I5 <br /> 0 TATTOCBODY PURGING ❑ p(jO1J5PA ` - CI LANA USE APPLICATION SITES <br /> ❑ MEDICAL.WASTE FACILITY CI PUBLIC WAT_:R SYSTEM C7 OTHER(PLEASE SPECIFYABOVE) <br /> �. 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 (east one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address Indicated above. <br /> 2. END will notify the applicant if any EHD files exist, An appointment for review will be confirmed <br /> approximately five lousiness days but no tater than ten (10) days afterreceipt 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 EHO staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> *• Any rile not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant- Future ffle reviews by the same applicant may require a $87.00 deposit prior to review. <br /> i• *TENTATIVE appointment dates must be-confirmed with EHD staff. <br /> i• Applications received after 3:00 pm will be processed the next business day. <br /> -ONFIRMED APPOINTMENT DATE TIME <br /> { <br />