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LIM I.OG NUMULII <br /> 01 'SAN JOA, -JIN COUNTYPUBLIC HEALTH SL- .VICES <br /> p - =• - ENVIRONMENTAL HEALTH DIVISION <br /> Irl 5+I -- ' 1 _ �r1 v 304 EAST WEBER AVENUE THIRD FLOOR <br /> OR <br /> CA 95202 <br /> .FEB 0 4 2003 (209) 468-3420 <br /> PUBLIC RECORDS RELEASE.APPLICATION <br /> �,� BUSINESS/AGENCY <br /> APPLICANT j ! C ,_ t .-f2 ( _ ��✓i!r f. ` `'- <br /> ADDRESS D <br /> PHONE <br /> FAGS Lit <br /> CC'' pi <br /> TENTATIVEAPPOINTMENT DAT[ TIME <br /> (11Icaso glvo 7 to 10 buslnass days from dato or'appl(catlon submittal) ' (/ <br /> CHECK BOX TO EXPEDITE REQUEST-$09.00 FEC-REQUEST PR CESSED IN 3 BUSINESS DAYS Un <br /> 1 �114 <br /> SIGNATURE OF APPLICANT DATE - <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCII <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION'FILES' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT' ❑ SOLID WASTE FACILITY <br /> I�L OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> . TIERED PERMITTED FACILITY O MOTEUHOTCL* O PUMPER TRUCKNARPICIIEM TOILETS <br /> O TATTOO/BODY PEIRCING O POOUSPA ❑ LAND USE APPLICATION SITES ' <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses In the space above. Select the type(s) of files from Ilio list above by checking <br /> the appropriate box(es). At least one filo type MUST be selected. Fax to (209) 464-0138 or mall 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 ton (10) 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 1s`actively being worked on by EHD staff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any file not returned ih the same condition as released will be reorganized by EHD staff at Ilia expense <br /> ofthe applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE., TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED, YES NO REVIEW DATE <br />