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�� ,-:•.v•�Ali.v::lr• <br /> DATE RECENED r <br /> SAN JC~ ,WIN COUNTYPUBLIC HEALTH St' <br /> IC�S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ST06KTON CA 95202 <br /> f J (2013)4$8-3420 <br /> RECORDS RELEASE APPLICATION ION ��s�. <br /> U <br /> � �P L�� - <br /> APPLICANT239 Shaa <br /> HUSItiESSIAGENGY <br /> A131�R15S ' l f <br /> PHONE — FACSIMILE I �/ <br /> r s <br /> TENTATIVE`APPOINTMENT DATE 1 J I�7't� yu -- inmE <br /> (Pleas©siva 7 to 10 4mtnitrAs A2Y5 frorn dam of application submittal) <br /> CHECK BOX TO j-XpEoITE REQUE - 74.00 FEE--RCQUE^T ROCI=SSED IN 3 BUSINESS DAYS <br /> IGNATURE OF APPLICANT DAT1= Xl <br /> FILE ADDRESS <br /> :a <br /> .�L IA a <br /> er <br /> 1 <br /> �. <br /> n � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK{UST)CLEANUP SITE(LOP) Q HOUSING AEIATEME'NT 11 SOLID wA5'1"E rAciuTY <br /> OTHER CLEANUP$1"M(NON-LDP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL Q DAIRY <br /> HAZAKDOUS WASTE GENERATOR a CHICKEN RANCH Q PKG TREATMENT PLANT <br /> TIERED PERMTfTEP FACILITY Q MCTELIHOTEL a PUMPER TRUGKIYAR.=JAEM•TOILETS <br /> 17 TATTOOIHGDY FORCING 0 P00USPA a LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 UTHER[PLEASE SPECIFY ABOVE) <br /> 9_ List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking <br /> tha appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0.1M or mail 12the <br /> addros indicated Qove. <br /> 2. EHO will notify the applicant it any EHD files exist. 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 Should be scheduled <br /> accordingly. <br /> 3. A file that is actively being-wQrked on by,EHD staff may not be Immediately aVallabief for reviow. A new <br /> application may be submitted when the#lie is available. <br /> 4. Any fila not returned in the Same conditiotn 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$73.00 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 business day. <br /> CONFIRMED APPOIN-rFAEN T,DATE ^, TIME <br /> DATE CONFIRMED - PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EK all id oiiasiva ---- --- <br /> r <br />