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rAA zu9 9480821 <br /> U10112�0001 <br /> wrEillra_';-o 111 1 <br /> SAN JOA—QUIN COUNTYPUBLIC HEALTH SERVICES fNeLiNNUNeER <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 3 0 2003 304 FUST WEBER AVENUE, THIRD FLOOR <br /> ST ) 95202 <br /> cNVIF;Uidk/I-A l HEAL <br /> (209(209 45) 458-3-3 420 <br /> t- rnl'rSFR1ll( F;WUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT '+ %�P /"l.� .r.GZ. BUSINESSIAGENCY A-c— C <br /> ADDRESS a-P�-S •�s>� �yJY 1-!.e S.!- -. --. <br /> PHONE yy.69'" /3yS -- <br /> TENTATIVE'APPOINTMENT DATE i�U 3 TIME <br /> (Please give T to 10 business days from date of application a;ubmRG-i <br /> CHECK BOX TO EXPEDITE REQUEST.387.00 FEE—REQUEST PROCESSED IN 3 SUSINEi5 DAYS <br /> SIGNATURE OF APPLICANT <br /> � /��,.��i _ DATA <br /> Lul <br /> FI :ADO S THIS SIOIi EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> /876 Cou..+r C/vs 7SI✓t i �r _ -- <br /> /A Y4 Cd✓-'L' C/v6 /✓� / <br /> Owl p.n+-. /✓S ) ✓L <br /> — <br /> l'-103 oun}-r CICS �!✓2. — <br /> A.57 S Com + ClvS l !vG JE- <br /> P, <br /> 70C c Cl7a5 Cov.,}r Club f31vd iJ -- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ..0✓UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0RID WA=iTE FAC[❑TY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Fr SOLID WASTE VEHICLE <br /> �'GRDERG ROUND TANK(MONITORING/REMOVAL) O DOG KENNEL D 01'[RY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKGTREA T74E.NT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PAMPER TRUCPJYARD/CHEM TOILETS <br /> 0 TATTOOIBODY PURGING ❑ PODLlSPA ❑ 1UNCI USE APPIJCATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM 0 O'fHI:R(PI.EA:>E SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to lz09) a6d-0738 or mail W the <br /> ddress indicated above. . <br /> 2. EHD will notify the applicant if any EHD files uist. An appointment for review Will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments could be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available, for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same Condition as released will be reorganizedby EHD staff at the expenl e <br /> of the applicant Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff_ <br /> 6. Applications received after 3:00 pm will be processed the next busine:>s day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX �T INITIAL.!; <br /> REVIEWED YES NO REVIEW DATE <br />