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Dec 09 04 02: 37p Hanbver Inc 530__?612 1490 P- 2 <br /> • t Ef{4 Lbt,lFLFd6ER 7 <br /> Jta�1WIN COUNTYPUBLl HEALTH SE <br /> i l l <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC $ 2004 304 EAST WEBER AVENUE,.THIIiD FLOOR i <br /> gTOCKTON CA 95202 ►) <br /> (20S) 468-3420 44// <br /> BLIC RECORDS RELEASE APPLICATiQN <br /> !.J la BuSINESSIAGENCY � <br /> APPOCANY L n e7 rf, <br /> ADDRESS i 1 <br /> PHONE 1355 FACSIMILE T <br /> l !,0N•r <br /> TENTATIVE*APPOINTMEDATE �� ° TIME <br /> give Tie 10business days from date v,application aubmlltai) <br /> CHECK BOX TO EXPEDtf!~REQUEST-$61.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> AS <br /> DATE <br /> SIGNATURE OF APPLICANT i <br /> FILE ADDRESSIS SIDE EHD STAFF USE ONLY <br /> ROO ELEMENTS SEARCH <br /> �f�z �• ya�,�-gyros <br /> �te3� �. �r�m vri St• \�� 1 <br /> 12 <br /> ENVIRONMENTAL NEALTH DIVISION FILES . <br /> UbI all UNDERGROUND TANK(U$T)cLEANUP SITE(LOP) R HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> l U FOOD FACILITY ❑ SDt.1D WASTE VEIiICLE- <br /> C OTHER CLEANUP SITE(NON-LOP) - C] DAIRY <br /> IIUNDERGROUND YANK(I41ONrt0PJNGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR Ct CHICKEN RANCH 0 PUMPER•C UCKIYARDICHEM TOILETS <br /> ED 'TIERED PERMITTED FACILITY ID MOTEUHOTEL In LAND USE APPLICATION SITES <br /> 0 TAyTOOISODY PEIRCING ❑ PI OUSPA ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY •ID PUBLIC WATER SYSTEMS <br /> 1. List up to ten addresses in the space above. Select the types}of files?from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 9 464-0138 r mail to he <br /> address indi aced above. <br /> 2. THD 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 receipt of application. The files <br /> wi!}be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A fik that is actively being worked on by EHD staff tray not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any thr., 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$87.00 deposit prior to review. <br /> S. "TENTA•i;NE appointment dates must be confirmed with EHD staff. <br /> a. Applieatk'�ns received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APP.0110.WENT•DATE TIME <br /> DATE CONFIRMED - - PHONE- FAX. INITIALS <br /> REVIEWER YES NO REVIEW DATE <br /> pi ou as YEN�I�o •." <br /> TOTAL P.01... <br />