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allU LVu NUM UAC SAN JO COUNTYPUBLIC HEALTH SERAIM 16 1 IRONMENTAL HEALTH DIVISION VFMW 04 EAST WESER AVENUE, THIRD FLOOR STOCK-fON CA 95202 (209) 468-3420 PUBLIP.RECORDS RELEASE APPLICATi N APPLICANT Jr A N G N.(I f g BUSINESSIAGENCY "SE, O N h - L, LAC J 1 ADDRESS I2.o31 f5L-j*'1` C014z 6 � _1�2 RP m d., A PHONE._ `{Z.5 -yY1Z — t600 FACSIMILE 377 -1(e,r TENTATIVE* AtsPauNsrwENT OATZ s 2s) o L TIME (Ple"o Ove 7 to 10 busineQ,s days from datate of aap'pNaadon submittal) Y CHECK BOX TO EXPEDITE REQUEST - $Si.00 FEE — R QUEST ROCESSED 7N 3 BUSINESS DAYS • 1 SIGNATURE OF APPLICANT �,,jDATI; i ...THtS SIDE END STAFF USE ONLY mn 1 M. V Sr 1. List up to ten addresses iri the apace above. Select the type(s) of files from the list above by checking the appropriate box(es). At toast one file type MUST be selected. Fax to (209) 46 0438 or mail to tbo ;kddrg•" ludicateO atyQyai , 2. EHO will notify the applicant if any END files exist. An appointment for review will be confirmed approximately five buslne&s days but no later than ten (10) days after receipt of application. The riles Will be held for a maximum' of five business days for review. Appointments should be scheduled accordingly. • 3. A file that Is actively beingi worked an by EHD staff may not be immediately available for review. A new application may be submi4ed when the file is available. 4, Any file not returned in vie same condition @ts released will be reorganized by END staff at the expense of the applicant. Future fil`� reviews by the same applicant may require a 587.00 deposit prior to review. 5: *TENTATIVE appointment ,dates must be confirmed with END staff. 6. Applications received after 3:00 pm will be pe'oce3sed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX YES :NO REVIEW Dj INITIALS P.01 ENVIRONMENTAL HEALTH DWISION FILES Oaf UP40E-RGftOUKV TAN.: (USi)CLEAN UP SrM (LOf) ❑ HOUSINP ABATEMENT O SOLID WASTE FACILITY W OTHER CLEANUP SITE, (NQM-Lop) • ! 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE W -UNDERGROUND TANK (MoNffoRiNrvRt MmovAt_i o DOG KF-NNEL ® DAIRY QKHAZARDOUS WASTE GENERATOR M CHICKEN RANCH 0 PKG TREATMENT PLANT W'TIERED PERMITTFM FACILITY D MOTEt1HOTEL 0 PUMPER TRUCWYARDJCHEM TOILETS 0 TATTOOIRODY PEIRCING L P60113PA -- - ® LAND USE APPLICATION SITES d MEDICAL WASTE FACILITY • ❑ PUBLIC WATER SYSTEM 0 OTHER (PLEASE 3PECUrY ABOVE) 1. List up to ten addresses iri the apace above. Select the type(s) of files from the list above by checking the appropriate box(es). At toast one file type MUST be selected. Fax to (209) 46 0438 or mail to tbo ;kddrg•" ludicateO atyQyai , 2. EHO will notify the applicant if any END files exist. An appointment for review will be confirmed approximately five buslne&s days but no later than ten (10) days after receipt of application. The riles Will be held for a maximum' of five business days for review. Appointments should be scheduled accordingly. • 3. A file that Is actively beingi worked an by EHD staff may not be immediately available for review. A new application may be submi4ed when the file is available. 4, Any file not returned in vie same condition @ts released will be reorganized by END staff at the expense of the applicant. Future fil`� reviews by the same applicant may require a 587.00 deposit prior to review. 5: *TENTATIVE appointment ,dates must be confirmed with END staff. 6. Applications received after 3:00 pm will be pe'oce3sed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX YES :NO REVIEW Dj INITIALS P.01