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Iw' �;/29f,2�,i�i`i��i 464p13� • <br /> `, E=NVIRONMENTAL. HEALTH <br /> r, x111_-,if ', ��.' �O1�QTT ©U�T1'Y PAGE ®1 <br /> ENVMON'ATE TAA MALTH MPARTmYNT <br /> 304 East Weber Avenue, 3'�F100r, St0040.n,CA 95202.2708 <br /> TclePhOn , (209)468-3420 Fax: (209)464--0138 W6b: vm-w.sjgo'v.or�ell <br /> PUBLIC RECORDS RELEASE ATMICAUON <br /> APPLIGAN'r: i rn a L"'/ � �,� - <br /> BU51NE55fAQENGY:"�1_ C+b N <br /> ADDRESS, 00 i. i YL 1 a l Gam-- 9 <br /> PHONE(1): Z PHONE(2): FACSIMILE: 2. <br /> TENTATIVE*AppoiNTmENr DAlt:,tel 11 ' 30 Aryl <br /> (Please atlavr 10 business days horn date of appllc,I(lon stUbtlittal--Tun b�an y�,nwt be conflrmad) <br /> 0 CHFCX BOX TO FXPEE)FM RE(ZU $95. (GASH OR CHECK ONLY).kEOUE.s r PRocEssED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATrz <br /> Electronic Information-, M List 0 Map-Description: <br /> FILE ADDRESS El�t7 USF,ONLY <br /> $treat# Street Noma City (QZ�• <br /> rt o dib- F: F unitz <br /> 4. unit 3 <br /> (f 6. ❑/tlnit a <br /> 7. <br /> ` g Units <br /> �\v - <br /> 10. h '^^ Unit S <br /> \ <br /> Specific Date Range of Information Requestod:From to <br /> ENVIRONMENTAL HEALTH DEPARTMEM FIL> S 7�� ,��7/��,� < <br /> E <br /> 0"MGRouND TANK(US7)CLEANUP STra(LOP) d HOMING ABATeJ�mr aL L,0 WASrE FACILITTNEHICU \1 L//d` 2- t "GFXCi.EAHUP SITE(N,ON-LOP) M FMD FACItm C.�-yVA.M TIPx <br /> AeRGROUNO TANK(MONITORINSIREMOVAL)V/ 0 Doo KrNNEX. Q DAIRY <br /> Xsans WASTE G"FPAVk✓ Ci CMCKEN RMCH I WWATM 7REAMENT PLANT <br /> 67-TWRM PnMrITM FACILITY CI MOTELIHOTUL M F'VMPERTRUCNUYARWGHCM'rdu.ETS <br /> 0 TAr0=1S0DYPIrxCIH0 M PaOUSpA =J�Ab USE APPLICA-VON$rms <br /> C1 MFUNCAL WASTE FActLITr M OTHER(I"Lema$pEsGlPY) <br /> WELL AHD SE"c PG MIT Recoaos ARcAVAULADLE FOR REVIEW• MoNvAY•pRmAY 4,.00 Ale-5:00PM 115XCLUDINO HOUDAYS. <br /> 1, List up to ten addressas in the space above. Solect the type(s)of files from the list above by checking tho appropriate <br /> box(es). At least one file typo MUST ba selectod, pax to 12091 4G"138 or mail W fh„2 addr9ss Indicated abbva Address <br /> ranges will not be accepted-for addltional=istanco with fila addresses,eonfact the Etia.Applications iocelVed after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notifythe applicant if any E141)fi;las exist. An appolntmont for review will bo Confirmed approxim3telyten(10) <br /> days after receipt of bpplioatiop. Ths films will be held for a maxinum Of five business Clays for review. Appointments <br /> should be 50heduhld accordingly. <br /> 3. A file that Is actively being worked on by EHD,staff may not be Immediately nValfeble for review. A nt)w application may be <br /> submitted when the file I$available. <br /> 4. Any file not returtied In the same condition as released will be reorganized by EHO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review., <br /> EHD USE ONLY <br /> T9 3JVd Tb8Z86L0TET ZT :5T 8OOZ/FO/Ta <br />