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61 �OPIi' ^1 tA' � � i tE rii'iu�GG i t 1 UU '+U I - <br />OA7� FEG V LV <br />SAN JO UIN COUNTYPUBLIC HEALTH SERVIf'TVnCES ENo�`01 <br />7 <br />„ <br />77*,EN'VIRONMENTAL. HEALT t <br />I* <br />304 EAST WEBER AVENUE, TH lei? 0# 1„ F t, <br />5 <br />!Yill- <br />�"{09) 4 8,342020��UBL1G RECORDS RELEASE A►PPL1GATlON <br />APPLICANTpMk I �[ jca BUSINESS/AGF-NCY C4v� oLC�r mar e, tL4s, o i 0 145 ►-tc. <br />ADDRESS 1:bF�a_►ti� � �il�Li�, �+�t_�`t �,,�__��aci�i as.� �� �iS2d fo <br />PHONEFACSIMILE <br />TENTA'T'IVE} APPOINTMENT DATE <br />(Phase give 7 tQ l business days�from data <br />C CHf~CK BOX TO EXPEDITE REQ1 JI ST - 587.40 F - F ST PRO <br />SIGNATURE OF APPLICANT -- <br />_ TIME <br />a ppkation sub Ittal) <br />�S f�ff <br />DATE 444,19- <br />z 1 `'i 9- D -02-- <br />FILE <br />Z. <br />FILE ADDRESS THIS SIUI- EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />1 b t to =rcz, � '-�- . <br />D 93 Ari r .V o v �% _ LA-)' - ! <br />-{ <br />i t - a. <br />I o I 'S. <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />},INDERGROUNI) TANK (UST) CLF.Ah1UP SITE (LOP) 11 HOUSING ABATEMENT LT-SpL117 WASTE FACILITY <br />i��nTHER CLEANUP SITE (NON -LOP) LJ FOOD FACILITY L7 OLID WASTE VEHICLE <br />rte' UNDERGROUND TANK (MONITQRINQ1RI5 OVAL) 0 OG KENNEL C�OLID <br />E�AIRY <br />HAZARDOIJS WASTE GENERATOR L� CHICKEN RANCH II PKG TREATMENT PLANT <br />CI TIFRE-0 PLRMrTTEi FACILITY 0 MOTELlHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />r7l TATTOO/BODY PEIRCING 17 PagL1SpA ` - , Q LAND USE APPLICATION SITES <br />Ck MEDICAL WASTE FACILITY M PUBLIC WATER SYSTEM 0 OTHIiR (PLEASE SPECIFY ABOVE) <br />- List tap 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. F to 09 464-0138 mail to th <br />t�.e <br />addross indi2 .Aboye <br />- 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 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, a <br />3• A file that is activoly bging worked an 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 fila not returned in the same condition as released will be reorganized by EHD staff at the expense <br />of the appllCant- Future file reviews by the same applicant may require a $87.00 deposit prior to review_ <br />5. "TENTATIVE appointment dates must be Confirmed with EHD staff, <br />6• Applications received after 3:00 prn will be processed the next business day, <br />GONFIRME0 APPOINTMENT DATE TIME <br />TATE CONFIRMED PHONE FAX INITIALS <br />