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(0/13/2002 23:37 170787732ift GEOIL�OGICAL P E 02/02 <br />L39—Q 1—��1 biy: t.3f N 1 h k1,M �1 <br />' 5 X YPUBLIC HEALTH Sh.RVICES V i1 <br />i .E TAL HEALTH DIVISIONAllah <br />4 EAST VYGBER AVENUE, THIRD FLOOR <br />STOCICrON CA 95202 <br />Ar <br />(209) 448-3420 <br />-� PUBLIC RECORDS RELEASE APPLICATION,r, <br />M <br />130INC3S/AGENCY <br />PHONie" ��� I 0 ' FACSIM11.11_ZV� / —5L7 / rni� er nnira <br />fiE4 •tom 1 1 Ei i, <br />—"LTYPTr��TQ Jvf� 4 H <br />TENTATIVE" APPO(NTMENY.DATL; (�_ E4z _ `_~%ZDOZ TIME c('� 00 /RL MIT/SERVICES <br />(P,easa'q:1we 7`to in $a da s `n tat DPNt,ea n 3ubmt(W) <br />4� G 1 OX TO EXISEDI'rE RECIU[ST = $87 C S L+US ESS DAYS <br />SIGNATURE OF AI�PPLICANT DATE % a?- <br />I <br />• FILE ADORNS$ -TFI19 SIDLI G°HCO STAFF" USU ONLY <br />r9OGKAM CLL•MENTS SEARCH .� <br />2)03 �:A <br />.21 571 ! rr12 'NJ <br />Tz>tac; ca <br />2 Z V Ql,,iAfrfllf &A-18 QL^I N <br />VAN <br />rr <br />s <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDE{RGFLOM(40 TANK tUST) CLEANUP S,TC (LOP) O HOUSING ABATEMENT C7 SOUD WASTE FACILITY <br />OTHEA CLEANUP SITE (NON -LOP) 0 FOOD FACILITY 0 5OLID WASTE VEHICLE <br />UNG GROUND TANK (MONITOKINGIREMOVAL) O DAG KENNEL. ❑ DAIRY <br />NAT.+vou3 WASTE GENERATOR O CHICKEN SANCH O PKG TREATMENT PLANT <br />0 719RUDPlt"ITT40IfhCIL,ITY 0 MOTELJHOTL:L D PUMPER TRUCKIYARDIC146MTOILETS <br />O TATTtpQ1I3ODY P6IIRCING 10 POOUSP6. O LANG USt APPLICATION SIT M- <br />6 MEDICAL WA3'rd FACILITY D PUBLIC WATER $Y$7C141 O OTHER tPLk--A$r.- SPECIFY AU*Vr-) <br />1. List up to tin addrerssos in the space above. Select the type(s) of filas from the list above by checking <br />I the apprup:iate box(es): At least one filo type MUST be selectsd. Fax tv `) 464.0138 or mail tq,,4hC <br />address indicated above. <br />2; i EHD will ridtify the applicalnt if any EHD files exist. An appointment for review will he confirmed <br />approximately five biAsinois. days but no later than tan (10) days after receipt of application. -The files <br />will bo hcltl'for a maximurli of five business days for review. Appointments should bre schedulcd <br />accordingly. <br />3. A Ilio that Ix aotivaly bainga worked on by EHD staff may not be immediately available for review_ A new <br />1 application Taay Oo 6ubri4wd when the filo Is available. <br />4. Any flle'not:raturned in the samo condition as roleased will bo reorganized by EHD staff at the expense <br />of the applicant;- Futuro flip reviews by the same applicant may require a $07.00 deposit prior to raviaw. <br />9_ ; *TENTATIVE_ appointment dates must be confirmud with EHD staff. <br />G. j Applications reaeNed after 3:00 pm will be processed the naxt business day. <br />CONFlI MED APPOINTMENT DATE TIME <br />DATE CONFIRMED HONE FAX INITIALS <br />YES _ NQ REVIEW r)A'rF TOTFL P•01 <br />