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S JOL 2 2 <br />I i•f <br />AP LF i <br />ADDRI✓SS 23 <br />SAI QUIN COUNTYi''i.. BLIC HEALTHVICES <br />NVIRONMENTAL HEALTH QIVISy <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STO <br />CiiT(3N CA 95202. <br />Z-001 (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />15USINESSIAGENCY <br />PHONE I t'7 - /06 FACSIMILE <br />w9--- <br />TENTATIVE" <br />9-TENTATIVE; APPOINTMENT GATE $001& _ TIME <br />(Please give T to 10 business days ft n data of aPpticafion submittoo <br />CHECK SOX TO EXPEDITE REQUEST - S _ 0 F QUEST PROCESUD IN 3 BU51NI 55 DAYS <br />SIGNATURE (T APE LICANT "' - - DATE 7,3 O 1 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON. -OP) ❑ FOOb FAGILTTY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONTrORINGIREMOVAL) Cl WO KENNEL a DAIRY <br />HAZAAOOUS WASTE GENERATOR ❑ CMCKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMIT'TEO a=ACIUTY 0 MOTELIHCM ❑ PUMPER TRUCKIYARDICHEM TOILETS <br />Q TATTOOMOIDY-MIRCING ❑ POOLISPA Q LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM M OTHER (PLEASE SPECIFY ABOVE) <br />«i <br />1. List r'ap to ten addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate boxes). At least one file type MUST be selected. Fax to 0491464-0938 or mail to tyle <br />address' Indicated above. <br />2. EHD will notify the applicant It any EHD files exist. An appointment for review will be confirmed <br />approximately fire business days but no later than ten (10) days after receipt of application. The files <br />will be held fora 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 available.. <br />4. Any Vie 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 $78.00 deposit prior to review. <br />S. *TENTATIVE appointment dates must be confifnied 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 REVIEW DATE <br />EN 00 74 DIM5M <br />