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OATjun •25 . 2003 1 :41 PM CONDOR EARTH TECHNOLOGIES Hi: :i,i�71ors Ni). I;l <br /> omvt JVt'll un-A COUNTY <br /> ENV JNMENTAL HEALTH DEPARTME. <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> fAi. lf-TALM, STOCK'rONCA95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT M f c-IA E-W NE !',• 1 BUSINES./AGENCY ��' �D� - %� �'-_ �' -'7C1� I OI.C► -I c,moi /,fit_ <br /> ADDRESS ! $ (��A 1�K- ►'V�.ST C t q-r-L-1;= ST 1t- I�Q GM;;'(-G1 k1^` <br /> PHONE ( � ) 3�f — a r 8' FAC-SIMILI. a?.3 4 d iz-Z - -- - - <br /> TENTATIVE"APPOINTMENT DATE — TIME _ , {�rAL. <br /> (Please give 7 to 10 business dakys from dale of application suturittal) <br /> ❑ , / �• <br /> CHECK BOX TO EXPEDITE REQUEST-SS 80 E-RE :iT PROC�3SE4 IN 3 SUSINES$ D/',YS' n <br /> /Jr �J v••e . <br /> 01, <br /> SIGNATURE OF APPLICANT rte / __ D ql"E, <br /> FILE ADDRESS THIS S 1DF EHI1 S-j-jhFF USE ONLY �— <br /> _ PROC R M El EHF:_ITIT,SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSIP G ABATEMENT ;:Ot-ID 1N I S7It FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY X :-DL.ID 1Mf�S.TIz 11EiHICLE <br /> JY UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG K::NNEL ❑ 11AFtY <br /> X HAZARDOUS WASTE GENERATOR ❑ CHICK[N RANCH ❑ PKG TR:E ATVLNT PLANT <br /> W TIERED PERMITTED FACILITY ❑ MOTEL HOTEL M PU99PEK TRUI'YJYARD/CIIEM TOILETS <br /> TATTOO/BODY PEIRCING ❑ POOUC,PA 0 LAND USE Ai'PLICATIOIN SITE 3 <br /> ❑ MEDICAL WASTE FACILITY C7 OTHER(PLEASE SPECIFY)_._._. _- <br /> 1. List up to ten addresses in the space above. Select the_ type(s) of file,;fF om ,he ii:;t above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (20!I �Ir4 4)"38 or mviil to Itle <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for r�,vivw ierill: be confirmed <br /> approximately five business days but no late,than teen (10) days after re,;eirr cif mlplil:ation. The files <br /> will beheld for a maximum of five'businoss c ay:for review. Appointrrlents :;houlci bf� sch-zduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHI:)staff may not be immed at;?ly L.valll.aibfe for review. A new <br /> application may be submitted when the file in available. <br /> 4. Any file not returned In the same condition a!; released will be reorgarlizad b if E-111) staff at the expfmse <br /> of the applicant. Future file reviews by the saime applicant may requirD a $i3 M d-Exposit prior to review. <br /> 5. *TENTATIVE.appointrnent dates must be corr9rmed with EHD staff. <br /> 6. Applications received after 3:00 pm will he processed the next businwis day'. <br /> CONFIRMED APPOINTMENT DATE � � TIME <br /> DATE CONFIRMED P40NE FAX ipirrIAL;:, _ <br /> REVIEWED YES NO REVIEW DATE I <br /> anarxM1 <br />