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OAT Jun •25. 2003 1 :41 PM C000-'- EARTH TECHNOLOGIES N,: .1.1)7 JOG NO • I/I <br /> JHI`/ JVI'l4EtJ11Y COUNTY <br /> ENVINTbNMENTAL HEALTH DEPARTME:r <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> :Ptt,'1F�G!(t1E�i f Ai. �IEALIfi° sroclKroN CA 95202 <br /> CFP`r 1 r F (2051)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 03 jUN 2b <br /> APPLICANT (-i 1" LL-1 N e !,.• 1 BUSiN£S-/AGENCY CO MDR- 1:=V1' R I-t <br /> ADDRESS I$ i`i�_A l�K- ►`��.�u C <br /> PHONE — Q .moi I FAC:i1MIL1: <br /> TENTATIVE"APPOINTMENT DATE--C7 L.�I�l TIME <br /> (Please give 7 to 10 business days from date of application submittal) �- <br /> CHECK BOX TO EXPEDITE REQUEST-3 00 E-RE 5T PROCESSE_Q IN 3 BUSINESS DAYS�/ <br /> SIGNATURE OF APPLICANT f __ b.l1l"I <br /> FILE ADDRESS THIS SIDF EHi;aTAF1=U-v;`E ONLY <br /> PROC RLAE.L I-6AENTS SEARC H <br /> ENVIRONMENIrAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Ar,:Ot.ID N0l I$TI=FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY X ':DLJD W AZTES VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMIOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> .� HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH. ❑ F'KC',TM AT&4,ENT PLANT <br /> W TIERED PERMITTED FACILITY D MOTEL HOTEL d PUAIIPEIi TRVCWARD/CI1EM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE AI"PL_ICOTION SITFS <br /> ❑ MEDICAL WA$TEFACILITY M OTHER(PLEASE SPECIFY)___._._. <br /> 1. List up to ten addresses in the space above. Select the type(s) of file--:from-:hp list above by checking <br /> the appropriate box(es). At least one file typic MUST be selected. Fax to 20!1j40q-0138 or meiil to_ttie <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHO files exist_ An appointment for r,;,vi(!w lnrilt I)e Confirmed <br /> approximately five business days but no late,than ten(10) days after ret::eip- of appli(:ation. The fil(;s <br /> will beheld for a maximum of five business days for review. Appointments :;houlrl be sch.zduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immed iatitly I.vallable for rrwlew. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition wi released will be reorgarlizod Al it E Al) staff at the exp)nse <br /> of the applicant. Future file reviews by the salme applicant may require a $81.00 deposit poor to roview. <br /> 5. "TENTATIVE appointment dates must be con1rmed with EHD staff. <br /> 6. Applications received after 3:00 pm will he processed the next busine:is day. <br /> CONFIRMED APPOINTMENT HATE TIME <br /> DATA CONFIRUED P'gONE FAX II'111r1AL.;:, _ <br /> REVIEWED YES NO REVIEW DATE <br /> a�,�, <br />