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PAGE 02 <br /> 3/2003 15:1646403,` <br /> IV1RO1 NiAi_ f nTFi <br /> un�ti si .,.vLU - <br /> �rnl�oc.wuowh <br /> .�, SATS JOAQUIN COUNrYi't BLIC HEALTH SERVICES <br /> ENVIROhIN[BTAI,HEALTH 61VISION <br /> 304 EAST W1281 R AV ENUR,"rKIR6 FL00k � <br /> STOC;tf'I'Oia CA 95262 ' <br /> (-.09) 41311a420 2 0 J�JL r., PM <br /> IT,I . <br /> PUBIC RECURD3 RELF-ASE APPL,ICATIO <br /> APPLICANT ,� f.I� #f- '- �tIStM:5S1/1GitNCY <br /> ADORFxSS CGt d1a1 1,D I Y <br /> PROMP, o0 p assn I11.,; `�25 • C l2 <br /> TENTATIVE*APPOIN7'1 EIIT DATE � M 7� Q d� � TIME <br /> (taiaa9a 4l+vo'r Co it buslna � *�days rnm cwto of apt n,amlon submktall <br /> Q CHECK BO X' <br /> TO EXPEDITE^RG S1 T-i .00 F — CQ IEST F ROCESSED IN 3I EOWNESS DAYS <br /> ,*SIGNATURE OF APPUCANT '"`�'� <br /> DATE 1 b <br /> fI <br /> fi[i.0 ADDRESS I� THIS SIDE 6STAFF Use Ony <br /> PROGFtAA SLIM11=1M175 SEARCH <br /> Ax OIC <br /> GI <br /> L1 - <br /> l� <br /> �^ I. <br /> ENVIRONMENT At.H1:ALTH DIVISION FILES <br /> tittormaftobkD TANk(UST)CLEANUP SITE(LOI) ❑ HC uStNG A9AT"ENT i! V,'SOLm WASrtr FACtUTY <br /> OTHER CI.EMUP SITE(NON-LOP) Cl FC CU FA NUTY 0 30U0 WASrE VEMCLF- <br /> UNDt RaROUND 7AKK(mQ1lIroRIHGIm:movAL) 0 0('G XE?401. ❑ VAHM i <br /> HAZAMOUS WASTE GENCRATOR 0 Ck ICnN RANCH ! C1 PKC-TREATMENT PLANT <br /> T1ERO PERMITTED PAWL" t3 N(rrl;I.19ML fl PUk4VRA'r1RUCWYARptClii:15ftILM <br /> t7 TA1700MODY P91ROING b PC OLISP 4 JQ VMD USE APPLIGA'f N SITES <br /> MEDicAL wAsTr;FACILITY 0 OTHER(pLFAsE SPECIFY ADOVE) <br /> 9. List up to ton addresses in the spaoc obtvvo- :,alact the types)of files from the list above by checking <br /> the appropriate box(es). At least one flla type MUST be selected, Fax L019091464 138 or mall ta_the <br /> w drays indica a above. I" <br /> G 2. EHO Will notify the apPli0artt If any'EHD files a Gist! An appointment for raviaw wilt be confirmed <br /> appraxifrlatoty five business clays but no later than tan-(10)days after r9ceipt.0f application. The filca <br /> will lee-hold fora maxlm4rn of five busirnt•ss days for review.IIAppointments should be scheduled <br /> accordingly. I <br /> 0. A file Uut,l&actively being worked on by END staff may not be Immediately available for review. A n" <br /> application may be.aubmittod when the 1 iia Is avallable. II <br /> Any fila not retU#rned lfI the same eandlSwas released will bo reorganized by F-HD stetrat the expanse <br /> of the applicant. Future rile ravlo'W F by V'a same Replicant relay require a $89.00 deposit prior to review <br /> 5• 'TENTATIVE appointmetlt dates must be aonlilmod with EHDI staff, <br /> 6. Applications recelvad after 3:00 pin Will Ito prc cessad the tie'lxt business day. <br /> CONFIRMED APPOINTMENT DAIt., <br /> TIME <br /> DATIE CONFIRMEDI� <br /> PI ONE FAX INMAALS <br /> T EV1EV4l>=D YES h10 RMEW DATE ' <br />