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ENVIRONMENTAL HEALTH PAGE: 01 <br /> iS)AN JOAQM CouMy <br /> 'ENVIROMUNTAL HEALTH DEPARTMENT <br /> 0 <br /> 3. 200.8 304 East Weber Avenue, P Floor, &00ktan,Qk 9520" -2708 <br /> 2 <br /> ',HEAL1e10P119B0-(209)468-3420 Fax- (209)464-013-8 Wtb-­www,Sjg0V.0r39,Ch2 <br /> PUBLIC RECORDS RELEASE APPLICA'hON <br /> 6 IM J 9,14x/ . N C <br /> AwRess, 2500 _�aa!no k. t` 445 47 <br /> PHONE(i). M� <br /> PRONE.(2), I <br /> TENTATIVE*APPOINTMfiNT DAT9- Thna. ' 80 AfV1 <br /> (Please a11CW10bU5lr=3 dada k0th date of appuzoug"Submift!-- CUD mron ft 40"1, V-emit he confinned) <br /> I <br /> 0 CHSOX BOX TO EXPEOCIV REQU $O&Vff7)fr�ASH OR CHECK ONLY)• <br /> WEQU&T k0CESSED IN S�WSIRFSS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information; List❑Mqp-Descriptior-1: <br /> FILE ADDRESS <br /> EHD USE ONEY <br /> SRraat Street Name city <br /> rk t'.-, <br /> 4- uffit <br /> 6. <br /> T. <br /> ................ <br /> $pacific Data RAinge of Information Pwquustod,From to <br /> EWRcNmr=NTAL HEALTH DFEPARTMENT`F[L>Z <br /> -Nor-RaRouNo TANK(UTO CLEMUP GrrR(LOP) 0 HOW NGABANFMENT ' Lro WAST9 FP4LrrfIVERCLE <br /> Zest CLIANUF 41M(WON4WP) M FaunFACUTY 04VAs+g mra <br /> DMUND TANK'I r a (IZ0MTQR1NWMGVA) 0 DO*KENNEL a am.,ftlllj8WAS EIIU ONCK5N WCH =4VAVMWATMT$rZATWNTPLAhfT' <br /> rtrj�W <br /> rW r-A,:rL 'Mit El Mor-aHOTEL C7 PVMPM TRUWAIAMICHM T=M <br /> Q TAr00MDVP19RC[N0 P POWSPA CQLAN13 WE APPLZAnam SITEs <br /> 0 WIMM WAM FAMLITT Cl OTHER(PL5M11 SP5CA <br /> WELL AND U"Q KMY FMW"S AftAVARAOLK FOR Wnsw- MomAY-FRPAY RwO 0-5.00m - 11ftLuDwo HouoAvs. <br /> 1, List up to ton addresses in the space above. select the type(s)of files from the list abov:'q by checking the appropriate <br /> box(es). At least*no file type MUST ba selected. Faxlg 20M 404-0138 or met!to t1jo a".mass jpdlqatmd abiwa. Aadmss <br /> ranges will not be accepted-for a4difianal assistance with Ilia ad tosses,confacA the FEW.Applications racelVed after <br /> 3,00 pm will be processed the next businoss dq. <br /> 2. The EHD will notifythe applicant If any.BHD fflas exist. An OpPOIntment for ravidw will ba confirmod approximately ten(19) <br /> days after receipt of applicafloh. The films will be held for a max1mum of five buziness days for ravlaw. Appointments <br /> should be schedulad accordingly. <br /> 3. A fle that Is actively being worked an by EHEC Staff may riot be Immediately available for review. A now application may be <br /> submitted when the file Ls available. A <br /> 4. Any fliv not returned In the same i;onditign at;released will be rGareanizet!by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require q$95.00 deposit prior to revfew.,, <br /> EHD USE ONLY <br /> etas WIN= <br /> TO 39Vd Tt,97,86LOTCT LI:ST BOOZ/EO/TO <br />