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RUG-26-2002 15:4? <br /> MONTGOMERY WATSON <br /> Sf&rOAQUIN COUNTYPUgLIC HEAL ' SERV1C _ <br /> ENVIRONMENTAL HEALTH DIVWgN <br /> 4?49 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> sT )ON 3 95202 <br /> (20 <br /> (zDs)aha-3az0 , <br /> PUBLIC RECORDS RELEASE APL.IPLICATIO tj !D <br /> APPLICANT <br /> nI�M.,f' Ta�1 fl l s Y BU ME53fAGENCY <br /> Y2� 1 <br /> ADDRESS al'IO TY2t�1 C1`V(�y.�S N'1'kC -300 2S__ <br /> PHONE qy5 "�i7i"IlI I)C�q FACSIMILE�`I/1• � S �� FII/(,D,�1� „ �TI"I <br /> PERMIVSERVICES <br /> 5 ti Z:T,a �,�.� <br /> TEIJ fATIVE'APPOINTMENT DATE 1 I 2 date appllcal of SU)�mitlal) <br /> (Pled d f t � <br /> BUS ESS BAYS <br /> CHECK BOX 70 EXPEDITE REOU 0 EE-R UE -- <br /> 8 � v <br /> SIGNATURE OF APPLICANT DATE <br /> THIS 31DE EHD STAFF USE ONLY <br /> FILE ADDRESS <br /> PROGRAM ELEMENTS SEARCH <br /> p 1�2 (olntkl La <br /> Ear- AlJrV, <br /> i cK1 <br /> W <br /> b <br /> s <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Ig SOLID WASTE FACILITY <br /> ri <br /> 00 UNDERGROUND TANK(U$T)CLEAMIUP SITE(LAP) NG P FO DIFACILITYEMENT ¢t SOLID WASTE vEHIC4E <br /> Dr OTHER CLEANUP SITE(NOWLOP) O DOG KENNEL 17 DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) O CHICKEN RANCH PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR O M ICKEN AN PUMPER TRUCFOYARDICHEM TOILETS <br /> SITES <br /> )g'TIERED PERMITTED FACILITY 0 POOLISPA LAND USE APPLICATION OTHER(PLEASE SPECIFY ABOVE) <br /> 0 TATYOOIBODY PEIRCING �V PUBLIC WATER SYSTEM VE) <br /> 0 MEDICAL WASTE FACILITY \ <br /> q, rom the list above by checking <br /> List up to ten addresses in the space above. Select the types)of files f <br /> the appropriate boxes) At least one file type MUST be selected. Fax to 209 464 0138 or mail to the <br /> addvess cated above. lication. The files <br /> z• EHD will notify the appl cant If any EHD files exist. An appointment for review will be Confirmed <br /> appiroximately five business days but no tater than ten (10) days after receipt of app <br /> will be held for a maxirllum of five business days for review. Appointments should be scheduled <br /> lobaccordingly. <br /> 3. A file that is actively b}Sng worked on by EHD staff may not ba immediately avEHDlstaff at the expense <br /> appllication may be sul)mitted when the Tite is available. anized by <br /> uire a E89.00 deposit prior to reviev <br /> 4• Any fete not returned itl the same condition as released Will be reo <br /> of the aPPlicant. Futu 10 rev[ <br /> ointr't ntldates must be Confirmed with EHD Staff- <br /> 5* <br /> `TEIJTATNE aPP <br /> 6. Applications received after 3:00 pm will be processed the next business ay. <br /> TIME <br /> CONFIRMED APPOINTMENT DATE. INrfIALS � <br /> PHONE FAX <br /> DATE CONFIRMED <br /> oov�d�r nATC TOTAL P-01 <br /> 12c •,n <br /> O G,lIC,�ICn <br />