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---41:�v-22-02 02 :04P Hers' Associates Inc. 636-9'Aq-9757 P.02 <br /> SAN RAQUIN COUNTYPUBLIC HEALTH SER I ',ES <br /> a ENVIRONMENTAL. HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ` 1073 <br /> STOC"ON CA 93202 <br /> (209)"B-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSfAGENCY <br /> ADDRESS 9Oux--r--woob . -'�r(-'70,Wts mo <br /> PHONE - FACSIMILE <br /> TENTATIVE•APPOINTMENT DATE TIME - <br /> (Please give 7 to 10 business dwp from dile of applicatl <br /> CHECK BOX TO EXPEDITE REQUEST-$09.00 FEE-R U-ST PR ESSE�S D <br /> F <br /> 4 SIGNATURE OF APPLICANT DATE 11- q OU <br /> FILE ADDRESS THIS SIDLE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> L <br /> 'Woo sim <br /> ENVIRONMENTAL.HEALTH DIVISION FILES S w leg <br /> UNOIERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT A SOLID WASTE FACILrrY <br /> OTTER CLEANUP SITE(LION-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(IMONITORtNGIREMOVAL). O DOG KENNEL O DAIRY <br /> O HAZARDOUS WASTE OENFRATOR O CHICKEN RANCH X PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY O UOTELMOTEL O PUMPER TRVCK/YA 0I`CH9M TOILETS <br /> O TATTOOmooy PEIRCING O POOUSPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses In the apace above. Select the type(s)of files from the list above by checking <br /> the appropriate box(*$). At least one filo type MUST be selected. Fax to(2091464-0138 or mtlil to the <br /> address indicated abovg, <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ton(10)days after receipt of appticaGon. 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 boing worked on by EMU 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 rottirned in the same condition as released will be reorganized by EMD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. 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 />