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03/25/2005 15:01 2097950 APERIO INC PAGE 02/0 <br /> e_ <br /> R E Com ' SAN JC►AQM COUNTY <br /> . FINVIRQNmwl'ALIfFALTo DEPARTMFJ <br /> M_A `� 2005 3Q�}East Weber Avenue,3 Floor,Staaktbn,CA 95202-2708 <br /> ENVIRONMENT fiEP7Li�i Telephone:(209)465-3420]'ax:(209)46"139 Webs vvww sjgov'or /ehd <br /> PERMIT/SERVICESPUBLICRECORDS lELFASp APPLICATION <br /> 6USWESSrAGEN ._.Rio <br /> APPLICANT, <br /> ADM= PHONE c22' FAcsuH,�_ ��—W 3 <br /> PHONE py '^ <br /> `5` � , tea: <br /> 'i'ENTATNE"APPQINTMtEW AA from data 0 i�Ppc7ltlon aut,al+tial-'Tor�twdve aRIY-mwt be c«sflrnud) <br /> (Please snow 10 truslr =days <br /> ❑ CfiECK 80X TO W&VrTE RCQUSST-�93.00 FEE <br /> (CASH <br /> Qty CHECK pNl Y) REQUEST PROCI=S M W a BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APRLICANT <br /> 1111111 =4uNri p1STRt8UTI0�t o Unit i ak Uaf t�t Unit UNt i <br /> �E3 <br /> ��"�t "°PSI <br /> FII ADDRESS EHD USE ONLY <br /> Street Nam" city <br /> 1-0 <br /> 2. <br /> ./ 3. cf <br /> A- <br /> -T— VA e,6. 0 <br /> oG <br /> T. G <br /> B. 5 oc.k r <br /> 9. ri <br /> d0. <br /> Spoci9e Dato ROnge of Informai:lon Requested:From d to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILE$ <br /> SOM WASTE FAa <br /> Uwlxowleouljc TANK(UST)CLIEaNUI�awn(L C3Food FAO mr <br /> C3 HcusW AeATIRMAW <br /> XQ CLEANW SITE(NON-WP) O[)oc4 K1111 i T ? ,j <br /> U")tXGRouFNarAW(M1OMMUGMMOVAL.) GwA.rMATMT�►TuWrPL.ANT <br /> aW.00U WA 7E G8NERAT0R ❑M CHICKEN <br /> N RANCH 0 � <br /> PVR'rF=UYMdCHENI TOILETS <br /> in Totm Pe[i1Nimu F�=TY 173PoOLISPA A 1 allo use AppL1CAT10N$tiE9 <br /> 0 TAT OW10PY Pa ReffiG LI r.�TtKR(P��R'arW <br /> 0 MaMCAL WASTE FAMITY HOLIDAYS. <br /> VYCILAND�Er7fC PE.WT FMg06 �utr.AVA0.ARLE Fw Re Ver- �ONDAY-F400 8.00 AM^r�,QQF9 - �' <br /> 4. List up to ten addlroacva in the spao0 above. Select the.types)of files from the list above by checking the <br /> appropriate box(es). At Iwast one file type MUST b0,selected- Fax to t2 9146 mail to the addrsa� <br /> indicated A ov ,Address ranges vWUI Ilot be accepted—for Addlt MW asstStance with file addrwte4ee,coatAat <br /> tate EHD.AppUcado"s►reccivcml after 9:00 pm will bay proccGood the next business day, <br /> 2. The Etip will ttatlfy the applicant if any MID fllee exist An appointment for review will be COFIftrmed <br /> approximately ten(10)days after reaelpt of application. The files will ba hold for a maximum of We buSIRPSS <br /> days for review. Appointments should be scheduled a coordingly <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately avallable for review. A now <br /> application may be submitted when the file is 0valteble. <br /> 4. Any file not rets ped In the salne condiUgn ae rolea►sed will be reorganized by END staff at the expense of the <br /> applicant. Future He reviews by the same applicant tray require a$93.00 deposit prior to review. <br /> ;,r-(j <br /> >h <br /> tato�z� <br /> „restos <br /> m � ,� u iu_&ninATAkM R�ZRb9b b9 5Y 002f9�f�0 <br />