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SAN J04QLJIN C OUNTYPUBLIC HEALTH SERVICES <br /> JVIRQNMEN7AL HEALTH C]IV1SfG. �1 - <br /> n U SA.FHqM —304 EAST WEBER AVENUE,THIRD FLOO� --t-f— - p� <br /> STO FOTO <br /> C NCA 95202 <br /> 5 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT U <br /> f3 <br /> J'ie JJ «i USINESSIAGE [ <br /> NCY ad <br /> .,.,,,,d C(� <br /> ADDRESS -7 Q !!J• UJ1l �� Ql� [ (� iW .1a�// s— <br /> PHONE 1 AG5IMILE // [fHa o— <br /> C �^ <br /> i <br /> TENTATIVE APPOINTMENT ! <br /> rM r�ATeZnrK1= _ xf — z � <br /> (Please give 7 tv�D b sines days from data of application subnii�l) M qp <br /> � � <br /> M <br /> CHECK BOX TO EXPLEDITE REQU T-178.00 FEE-KE6TUt: T RO ESSE0IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> i FIVIE A KESS <br /> ` E <br /> r <br /> d lc.rQ <br /> Cry / r O <br /> �1 3U <br /> d C-7 5,0) - Di <br /> tt3 ' I J91& SP <br /> * Pro , n6 r i tes ... tis`te t>na VI- b 8 .. „RUTH R"a 4"9.9t) �.VoT�.R a r l <br /> ENVIRONMENTAL 11 ALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SfTE(LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY n SOLID WASTE VEHICLE <br /> UNDr=RGROUNb TANK(MONITORING1REMOVAL) ❑ DOG KENNEL. C7 DAIRY <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ nERED PERMITTED FACILITY Ll MOTELJHDTEL ❑ PUMPER TRUCK YARPICHEM TOILETS <br /> ❑ TATTO01BODY PEIRCIHG Q POOL/SPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ';yCoTHER 1PLEASE SPECIFY AE IO <br /> uj- Q�t5� � `hc vs,�.acid r, <br /> i. twist up to tan addresses In the space above. Select the type(s) of files from the Ifst 21bove ty checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD 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 (90) days after receipt 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 EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will b$ reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same appilcant may require a $78.00 deposit prior to review. � <br /> S. 'TENTATIVE appointment dates must ba corifirmed with EI-4D staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME f <br /> I <br /> D,ATE CONFIRMED PHONE FAX INITIALS � <br /> REVIEWED YES NO REVIEW DATE _ <br /> EH 00 14 01RyA9 <br /> 1 <br />