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07/08/2002 MON 12;50 FAX 916 5654356j001/001 <br /> K r i UW cnn< 1 h:qts 4 iEi EhVIRONME NTL 1EALTH PAGE 01 <br /> _AN JOAQUIN COUNTYPUBLIC HEALTH H SERVICES o+c;tioaaur�aea <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ' , <br /> STOCKrON CA 95202 <br /> (209)463-3420 <br /> PUBLIC RECORDSRELEASE APPLICA11ON <br /> APPLICANT <br /> r_ 13uswF_SSiAreNCY <br /> ADDRESS <br /> PHONE n9/�-� �Yr � FACSIMILE <br /> - TENTATIVE*APPOINTMC'NT DATA= 77MC <br /> !.1 (Please give T t i ess appU submittal) <br /> CHECK SOX TO EXPEDITE REQUEST_ ,�F 15T OCESSED 1�3 t <br /> -' - NESS DAYS <br /> S1GNNeURE OF APPLICANT - <br /> Cr DATE oL <br /> FILE ADDRESS THIS sIDE CHO STAFF use ONLY <br /> PROGRENTS SEARCH <br /> a sz <br /> Al X,0 <br /> r <br /> •c� <br /> �Y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Rd UNDERGRoUNo TANK(UST)CLEANUP SITE(LOP) M HOUSING A13ATEMENT 0 SOUR WASTEI <br /> ❑ OTHER CLEANUP SITE t•NON-LOP) D FOO(]FACILITY ❑ SOIJD WASYE LITY <br /> FACVEHICLE <br /> ❑ UNDERGROUND TANK(MONITORwGrRElslovAl) ❑ DOG KENNEL d DAIRY <br /> 10 HAZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑ PKG TREATMENT PLANT _ <br /> C1 TATTO PERMITTEDIRCINGIYfY ❑ MOTEt1HOTEL l7 PUMPER TRUCr4YARO/CHEMTOILETS , <br /> ❑ MEDICA WASODY E FACILITY <br /> ❑ POOLISPA Q LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACItrCY a ❑ PUBLIC WAYtrR SYSTEM r3 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tett addresses in the space above. Select the type(s)of flies from the list above by 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. LHD will notify the applieant 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 rocelpt of application. The rites <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;avallobte. <br /> 4• Any file 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$89,00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates trust be confirmed with EHD staff. <br /> .6. 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 ftEV11YV DA�....— <br /> •nni�nr"-'- <br /> Post-ie Fax Note 7671 ? r <br /> To t2From <br /> A <br /> cal�ept 37t r <br />