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SAN JOAN 'IN COUNTYPUBLIC HEALTH S $ #CES <br /> Ef RONMENTAL HEALTH DIVISION1 0010�� <br /> 304 EAST WEBER AVENUE, FLOFLOORTOCK ONCA 95202 <br /> : (209) 468-3420 <br /> -x�++,,1I111J MAR 0 6 2000 PUBLIC RECORDS RELEASE APPLICATION <br /> kPPLYA ' <br /> R�lvf ' r �`N_ <br /> ql TN gU51NESS/AGENCY ��.PERN� T / ,ADDRESS 7 S r� <br /> PHONE ._1'1�t -ZZ?, t t Z -- FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �4 �� , DATE , , (7 CC) <br /> I <br /> FILE ADDRESS <br /> 2V 0 <br /> I 4 <br /> 1. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �DERGROUND TANK(UST) CLEANUP SITE'(LOP) ❑ HOUSING'ABATEMENT 0 5oL€D WASTE FACILITY <br /> �THER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> �,�'/UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> P HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> G TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDlCHEM TOILETS <br /> ❑ TATTOOIBODY PEIRC€NG ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types) of files.from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0938 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business clays but no later than ten (10).days after 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 /> 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 file 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 /> 5. ".TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> w <br /> DATE CONFIRMED PHONE FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> �I <br />