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f' <br /> I T FJlU L3X%:ihMLi <br /> � <br /> ® t39-1.3pri �ES <br /> 03-�12FJ�l <br /> �UtN COUNTYPU8L4C HEALTH :•-N <br /> el <br /> ENvt1 o MFa�c. <br /> �� KE/ <br /> kL-tH >atvLOOR <br /> 304 EAST WEBER AVUF, Tl(iFtfl F �[�R <br /> 5N <br /> STOCiCTori CA 25202 <br /> fl 1 (209)465.3420'' <br /> '_ ... <br /> 'sALl H PUHL- LIG R�CQRDS RELEASE APPLICATION <br /> _ �:•I' 6u91ii S5JA6ENCY ! ~ <br /> njAPPI iCAN 4� <br /> ADDRESS m I ' <br />• �I.p Lr7'••-i' �LOQ FACSrtdtL� '%;t <br /> YtiONE �� �D� -ME A, <br /> ca <br /> ENTATIVE* al <br /> ApPi31NY ts'lEl+ll DA7P s from data of appllcatlan subms") <br /> {P19Ase�iYs 7 SA SO btrslM1esg <br /> GHEC SOXCOf DTT3w1tl'GtlfliSC.V8.40PEE—R�f ES�PRfAC�S9E�11N3&LlSliifiSSDAYS <br /> DAT 5 <br /> SIGNAT RE OF APPLICANT <br /> 1 <br /> �pQG,�1 FOMENTS STAFF USE <br /> i"ILE AUO SLY <br /> F2ES6 � <br /> NLz. <br /> tam <br /> ,s <br /> _ <br /> ElUY RONMi=f�iTAi_HEALTH DIVLSiOI+x FILESS <br /> i`= <br />{ CI %0USIN3ABAiVMEN7 G SOLJD;# TEFAGgj <br /> III i1NDE Fi4Lr1zRTAtIt tUST7 CL£P+N�1gSIT�(LOF) 0 MOD FAIA Tl'. Q SOUDWASTG VEHICL4 <br /> 5d CrrHEFI CLEANUP am(NON-LOP) C� pq4 K�NEL 0 pAltiy <br /> jjKD (3WU D-rANK(M0NrrOMH=Eb1oVAL1 0 G4iG M RANCH .TD pVo TaEATM19'r PLAM <br /> t1A1r�us WASTE GENERATOR U CHIC1<914 REL Q PUSIPER TRU40MAft17lCHF-M TOi1!~FS <br /> 7iItiRE pefWITTE.D FACILITY Q POTF-VI4A C] U4Ha USE AppUGATIOM SITE <br /> El TATTEOSODY B£IRGNG C1 pumm WATER$Y5TEIYI O OT FI1wR{pLF�3fi SPECIE" A6OVir3 <br /> I. CI MFD)C WASTE FACtLrrY <br /> s a!i�te5 from tho►list move by Checking <br /> g- LiSt up to ton addresses in tine space move:'$elect the typed 2{]9 13 r mai tme <br /> the appropriate box(es). At least an*file fypa MU ,bB sotected_ F <br /> 04ALess.in ' e dve- itttrctettt for review will be canf rrned <br /> I 2_ EHD will notify the appllcarrt If any EHD files e7Clst:' ��� cation, Ttte Rtes <br /> approximately f"iva but Iness day$but no later than ton(10)days after rece;pt t of Of aa cipp4ischeduled <br /> thrill be held For a maxltnum of five business days for review. Appointments <br /> shouaccordingly, <br /> I 3. A file that is actively being worked of by EHD 02ff may not be hnmediatsly availabt$far review. A new <br /> application may be submitted when the file Is sv*ilable. <br /> 4. Any f[le not returned in the$ante cdndttt�rl as relsased sWtt mer reorganized <br /> a$79.00 depva}t prior to rt�BW. <br /> of tits applicsnt. f=uture file revWW&by a saute spp may <br /> r, *TENTATIVE appointment Batas must be confirmed With EHD off. <br /> 6. Appl;cations received afttr 3:00 prn Will he pr4GeySed the next business day. <br /> i <br /> GONFI�MED APPOINTMENT DATE TIME <br /> BATF G nEt~IFtMtWD _ PHONE FAX INITlAI-S <br /> REVIE F) YES NO R1=VIE1N 17AT� - <br /> 40 94 <br /> TOTAL. P-02 <br />