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u0/1z/U3 'TUE 09:56 FAX 19258272029 SHAW E & I 1j I <br /> DATE RPCEIV@p ~""" 'b o of <br /> ENVIRCtIMENTAL t" �TTH <br /> SAN JOA, . P,� e1 <br /> N`VX�p � QUXPT COLS'iTy: �,IJ 16�'IIXTiorr% <br /> _"�i NTAL$EAI. ]I,EPAiTME <br /> 304 Weber Ave 3'd Floor Stocktc,rJ, CA 9520 N' <br /> t l {209} X68-342p Fax:{209)464-OI3& Web: www,cc;r,sari' 11 <br /> J0119 ca-us/ehd <br /> PUBLIC RECORDS RELEASE,ippLICATION <br /> APPIJCANTI_�(,�(�r:'ADDRESS- <br /> � <br /> BU91NES9/AG$AICY:�..��i /.edl�l <br /> PHON$• <br /> I FACSIMILE '' 2d <br /> a. TENTA 1IVE*APPOINTMEWT DATE: ��' Ik ;� <br /> I Tl ZAV <br /> (please allaw 10 basl,ms daySftm date ofa licetiori submIftw) <br /> f�l�� <br /> CHECI+C SOx TO WE RITE REQUEST.$93.04 FEE REgUFST PROCESSEa <br /> SIGNATURE OF APPLi c IN 3 9LISIN9$3 DAYS <br />` �t <br /> ='�--- DATE ff <br /> I beaalsmetlt Use aruy <br /> u, <br /> FILE AD �ti <br /> UNIT <br /> Un <br /> ii 9 <br /> it2 <br /> j1 <br /> Unit 3 <br /> ° s a ! Unit d <br /> ,o. so , _. I <br /> Ili ,I ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPART'IIIENT FILES ;I <br /> UrvDSRGROUN0 TANK(L ST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT I� SOI WASTE FACILITY <br /> OTHER CLEANUP SITE(I�'ON•L.oP) A FOOD FACILITY Q <br /> Q� UN13ERGROUND TANK(A ONIT'ORINGIR::mcrvAL) D DOG KENNEL Sotto WASTE VEFTICLE <br /> Q HAZARDOUS WAM GEI IERATOR C] CH�KEN 0 DAIRY <br /> O T1!?RED PERMtTrTED FACT LIN. RANCH L] PICG!TREATMENT PLANT <br /> Q TATTOOMOoy RIEIiCING a p U9PA 1• t3 PUMPER TRUCKMARCYC SEM TOILETS <br /> d hti;GICJIL WASTE PACILII Y © LAND USE APPLICATION SITES <br /> OTHER(PLEASE SPSCIFYI <br /> 7• List up to ten addresses In the Spate above. Select the typefs)of fifes frim the list above by checking <br /> F <br /> the appropriaf a box(es). At least one file type MUST be sela(Aed. to 20 4S 138 or mail to-the <br /> Address indicated above. } <br /> 2. EHD will riewp i the applicant if any EHD fifes exist, An eppol Istment for review will be confirmed <br /> approXirnately five business days but no later than ten(10)days a r reCQIpt of appllcatfon, The files <br /> will be held fo•a maximum of five business clays for review. <br /> accordingly. Y Appoi1 tmerl, should be scheduled <br /> 3. A filo that is actively tieing worked on by EHO staff May not Ile Immediately available for review. A new <br /> application m:iy be submitted when the file is available. <br /> 4. Any file not re'urnod In the same condition at released will bit reorgantzed by END staff at the expense <br /> of the applical It. Future file reviews by the same applicant III ay raquire a$93.{)0 deposit prior to review, <br /> 5. "TENTATIVE appointment dates must be confirmed with EH C1 staff.j"� <br /> 6. Applloations r loelved after 3:00 pm will be processed the m;:i:t business day. <br /> I� ;I <br /> COW IAMED APPOINTMENT DATE _ 'i 1111E - <br /> DAtF,CONFIRMED ^, PHONE I=r!X � INITIALS <br /> REVIEWED ES NO REVIEW i,')ATE <br /> ,o - <br /> erertvos <br /> �1 <br /> l <br />