Laserfiche WebLink
-- TO � � 15105522246 P.oi 14 <br /> O/O6 � YPIIBLIG HEALTH SE[UES s <br /> AL HEALTH DIVISION <br /> AVENUE,THIRD FLOOR <br /> ^( 0 TON CA 95202 MAR O 9 2000 I� <br /> W �G <br /> ))468-3420 d <br /> " ruts! tt, rcr�.vr�u� RELEASE APPLICATION wVIHO'ViVii_'N if, !-icALl H <br /> APPLICANT_p 0 be r-t <br /> e( t ' /Q 'FS <br /> OUSINESSIAGENCY .ev,, cice <br /> gDORESSC I r Ot�q I oW[J�G-��• 45,1. G/- N"7 <br /> PHONE J ID ? ,rJ !(i I JLn s FACSIWLE ( •SID <br /> TENTATIVE*APPOINTMENT DATE TIME 'ttt <br /> (Pleave gave T to i06uslness tlays hom date of appgcation subm�nap � i <br /> CHECK BOX TO EXPEDITE REQUEST-378.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS q <br /> SIGNATURE OF APPLICANT DATE ( o'�) I� <br /> FILE ADDRESS <br /> l� <br /> �3 o west =Id r. 230 s z7 <br /> S ro k � S'r _ �eaj,' <br /> ENVIRONMENTAL HEALTH DIVISION FILES if <br /> PUNDERGROUNO TANK(UST)CLEANUP SITE(LOP) [3HOUSING ABATEMENT 4 SOLID WASTE FACILITY <br /> Z OTII6R CLEANUP sr(E(NON.LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE �I { <br /> a e, NOERGROUNDTANK(MONIYORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY II( <br /> L7 HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH O pKG TREATMENT PLANT <br /> ib'TIEAEOIBODYP IRC;N0 ITT O MOTELHOTEL ❑ PUMPER TRUCWYAROJCHEM TOILETS if i <br /> ❑ MEDICAL <br /> WASTE <br /> - El POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WA5TE FACILtIY ❑ PUBLIC WATER SYSTEM 0'(�THE% L�E-A(gE SPECIFY A80VE) <br /> 9. List up to ten addresses in the space above. Select the �faZ �0. ' 6"S"�s' r") If <br /> 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(209)684-0138 or mail'to the <br /> Address indicated above <br /> 2• EHD will notify the applicant if any END fltoS exist. An appointment for review Will be confirmed <br /> approximately five business days but no later than ten 10 da II I <br /> Will be held for a maximum of five business days for reY I after receipt of application. The files <br /> accordingly. Y low. Appointments should be scheduled {;I <br /> 3. A file that is actively being worked an by END staff may,not be immediately available forreview. A new <br /> application may be submitted when the file is available.' i, <br /> A- Any file not returned in the same condition as released will be reorganized by END staff at tho expensef <br /> of the applicant Future file reviews by the same applicant may require ar$78.0D deposit priar to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with LHD staff i <br /> 5• Application received after 3:DO pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE II <br /> TIME <br /> DATE CONFIRMED fl <br /> PHONE FAX INYTIALS i� <br /> REVIEWED <br /> YES NO REVIEW DATE i <br /> tN Po to o�nsgo ` <br /> . _..._ _.. ._.. . . _ TOTPI P A' 1'f [ <br /> *w TOTAL PAGE.01 N- f <br /> III i <br />