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L� LEI� D\ SAN dQUfN GQL)NTYPUSLIC HEALTH SE CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> OCT 0 5 2000 aGa LST ST(>CKTON AVENUE, FLOOR <br /> (209)4615.3420 <br /> ENVIRONMENT HEALTH PjJgL(G RECORDS RELEASE APPLICATION <br /> APPLICANY BUSlNE55lAGENCY .,,,.. <br /> AODRE$5 (f�"I l.) p (j,1 �.. c�YY1-E./1dCl q <br /> PHONE l I 1 X35`F' ' FACSIMILE gl�� 12aZ` <br /> TETITATSYE•APPOINTMENT,I IH l�rlr- �J� <br /> (Plc oiY T to t D hUSiM.SJ t TS from"A Or appUwtlon Submittal) <br /> tIGNATURE <br /> ECK SOXTC CXKPITE R i QU $aTx FEE-REQUESTP OCESSEDIN 3 BUSINESS DAYS <br /> OF APPLICANT �� s DATE <br /> s <br /> -m FILE ADDRESS TxI*31PE EHD STAFF USE ONLY <br /> I PROGFWIA ELEMrNTS SEARCH <br /> Jaz; /3:i-/-C, ✓='V L--' ' P'iC <br /> :Pjjr'7,, 74, C/f <br /> � pp <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> .,y'/,UNDERGROUND TANK(UST)CLEANUP SrTE(LOP) ❑ HOUSING ABATEMENT ❑ SCUD WASTE FACIUTY <br /> 'fi OTHER CLEANUP SITE(NOWL.OP) G FOOD FACULTY M SOLID WASTE VEHICLE <br /> UNDERGROUNDTANK(MQNITQRIUGIBENOVAL) a DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR , U CHICKEN RANCH O PKG TREATMENT PLANT <br /> 0�ATFL ❑ PJMPERTRLCWYARWCHEM TOILETS <br /> GTIERED PERMITTED FAGITY MOD LAND USE APPLICATION SITES <br /> ❑ TATT001SODYPEIRNG <br /> ❑ IrcDICAL WAST£FACILITY D PUBLIC WATER SYSTEM ❑ 'OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List Up to ten addrisses in the space above. select the type(S)of files from the list above by checking <br /> the appropriate bv�C(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the lapplicaht it any EHD file* exist. An appointment for revlew will be eolrtirmed <br /> approximately five(business days but no later than ten(10)days atter receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> S. A file that I$aCtivei'beinglworked on by EHD staff may not be immcdiiataty available for review. A new <br /> application may belsubmi(ted when the file is available. <br /> 4. Any file not returned in they same condition as released will be reorganized by EHD staff at the expense <br /> 4f the!applicant. Futuro file reviews by the same applicant may require a$57.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be Confirmed with EHD Staff_ <br /> 6, Appiications received aftgr 3:00 pm will be processed the next business day. <br /> f � <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED i PHONE FAX INITIALS <br /> REVIEWED YES I NO REVIEW DATE <br /> TOTPL P.el <br />