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01/28/2002 13:29 2094673 AGC STOCKTGN t'Hu'T <br /> DATE RECEIVEDEHD LOG NUMBER <br /> JO�';(QUIN COU TYPUBLIC HEALTH S*VICES <br /> ENVIR304 EAOTjLTH IVISfUN r ` r. <br /> WEB RAVENUETHIRD STO KION CA 95202 �h:` I Y7A '' /�� <br /> aN 28 \2- <br /> Q� ( 09)468-3420 <br /> p2 PUBLIC RECORD 3 RELEASE APPLICATI/OCN <br /> APPLICANT lre�\U\ BUSIN SS/AGENCY • - <br /> ADDRESS 232 00 4 <br /> PHO DD FACSI TLE <br /> �a' ENTATIVE*APPOINTMENT DATE TIME _ o r <br /> Please give 7 to 10 busine s days from date of application submittal) ` <br /> CHECK BOX TO EXPEDITE REQUEST-$7&00 FEE—REQ EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT W DATE z$ �� <br /> FI E ADDRESS <br /> d \ . <br /> '4 4W- <br /> ui <br /> S z'� M L .21-0 <br /> s 5s <br /> .y8 <br /> �h 55 <br /> ;Lq.(otS LA aA <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HO SING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FO D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGfREMOVAL) ❑ DO KENNET. ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR C7 CHI KEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MO LIHOTEL © PUMPER TRUCK/YARDICHEM•TOILETS <br /> a 7ATTOOIBODY PEIRCING 0 FOI ILISPA - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PU.I LIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space abo re, Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file ype MUST be selected. Fax to (20g)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fi es exist. An appointment for review will be confirmed <br /> approximately five business days but no ater than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five busine is days for review. Appointments should be scheduled <br /> accordingly. i <br /> 3. A file that is.actively being-worked on by HD staff may not be immediately available for review. A new <br /> application may jae submitted when the fi a is available. <br /> 4. Any file not returned In the same conditio i as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be t onfirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will bit processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 90 14 0110WOO - <br />