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1J?1-b'/__'UW10 :2UMI Hh: fl lU I�_n r..ul <br /> „ uv, <br /> SAN JOAQ(JIN COUNTYPUBLIC HEALTH SERVICES <br /> EMVIRONNIENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> (2W)4saON�34iozoz MAY 7 2001 <br /> PU)3UCf RECORDS RELEASE APPLICA'T'ION <br /> • �ILili <br /> 141APPLICARTtca2'Z'Zo V BUSINESSfAGENGY ENV/nJ,�ns,vr� rrli-•.aas..s..r('�C�p„L�,�iA.G �, !-'j <br /> >h ADDRESS ~2d 3� 1'1 aC xSPR��v� /�i•ocl+ �/°Tl �Od <br /> PRONE JZS `�/3K- 5�� •-•-..FACSWILE_--. �;y--93� 7lGG •-•._.._ <br /> TENTATIVE*APpoiNTmENtoATE_,4 <br /> ,SA nmE tV"'n•t <br /> (Please 2i`*r to to nvs Hess day%"M sato of app40ation stomieat) <br /> CRECK SOX TO EXPEDITE REQUEST-yAT.00 FEE-REQUEST PROCESSED W 1 BUSINESS DAYS <br /> )LSiGNA-PURE OF APPUQANT DATES 6W f <br /> FILE ADORESS', f'1ND�� THIS SIDE EHO STAFF USE ONLY <br /> ALL F/e13.4 +LyS i k>�Al .4 YTFCA PROGRAM ELEMENTS SCARO N <br /> al•tKs SXlronr .1-52 E 4SEn'TI- A,vl3S•-Z-k /t/I L -- -- <br /> GM6✓JtaN - <br /> i -- <br /> r--Z E• ✓E CFlE" 1012 <br /> f21No ....Z/` svS•J� J_ w <br /> uN1eK 5Ht7 dao vase�.rs a✓ 3s�� tis.;-, -- - - <br /> f# co crag F71 yasZ,,o-E nnz '35-)-7 r--�. <br /> Trtar GoDr rwlwd }f`!S pj"f —CORTftE o35_­z7 LD <br /> SPRPCKs14 Sv"F? Go ( 15ri 29•s L <br /> urlaras7 Aa;RS .+a�c:s 3c7f /,r T71m1?E- Gsf-sr.� -- �� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP S1rE CLOP) 0 ROUSING A$ATEMENT 0 SOLW WASTE FACILITY <br /> O :OTHER CLEANUP SITE(NON-LOP) t3 ¢OOD FACILITY 0 SOLD TYA$TE VEHICLE <br /> 0 ;UNDERGROUND TANK(MONITORIN61REmOVAL) 0 DOG KENNEL M DAIRY <br /> 0 hAZARDOVS WASTE GENERATOR D CWCKEN RAHGH M PKG TREATM NTPLANT <br /> ❑ TIERED PERMRTEO FACILrrY ❑ MOTEUHOTEL C PUMPCR TRUCKRAROMMEAt TOILETS <br /> C2;TATTOOIBOOY PEIRCi1NG t3 POOMPA L03,LAND USE APPUCAnoN S"ES <br /> MEDICAL WASTE FAC1Lf Y CL PUBLIC WATER SYSTEM OTHER(PLFASE SPEt3FY ABOVE) <br /> 1. L[St up t0 ten addresses In he space above. Select the type(S)Of files from the list above by Chechiny <br /> the appropriate box(es). At least one file type MUST be Selected. Flet to(AR21684-013$gr-MAil,19•[he <br /> address indicato above <br /> 2. E110 will notify the appli"ilt if any EHD file*exist- An appointment for review will be confirmed <br /> APFMXimately five business days but no later than ten(10)days after receipt of application. The fifes <br /> will be beld for a ma)dmum:'of five business days for review. Appointments should he scheduled <br /> accordingly. . <br /> 3. A file that is actively beteg Worked On by EFS staff may not be inTmediately available for review. A new <br /> application may be submittw when the file is available. <br /> 4. Any file not returned In tha same condition as released Will,be reorganized by EHD staff at the expettse <br /> Of the appBeant. Future filq rbvfa by the same applicant n„y require a$87.00 deposit prior to review. <br /> 5. "TENTATIVE:appointment dates must be Confirmed vfdh EHO staff. <br /> 6. Applications receiyed"r'.3.00 pm will he processed the text business day. <br /> CONFIRMED APPOINTMENT DATE TldlilE <br /> DRTE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> TOTAL F.©1 <br />