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FF,'ON . Gao-FF.ase Environmerital Ir FAX' NO- 209y�G902�+' "'Tear-1. 1'9 2UOU 02:53Plll P1 <br /> N. <br /> _ <br /> SAJOAQt�COU !HU LUG t4uMUEKN7YPUBLlC HEALTH SERVI� U <br /> ENVIRONMENTAL HEALTH DIVISION Roj304 EAST WEBER AVENUE,THIRD FLOOR �Lis <br /> Pei STOCk[TOAi CA 95202 Lam,468-3420 .. <br /> PUBLIC RECORDS RELEASE APPLICATION R 1 9 2nnA <br /> APPt IGANT u�t t�Mt�Sar-I aUSINES81AGENCY d 4iR: �V���� p N FNprHEgLT <br /> ADDRESS 1.�13� Yl�rl.1�i+LQ.ra l� � —r�vbr 3 <br /> PHONE c�Z �jL�� Zit 3 FACSIMILE �r�y- S{g� 612% <br /> i ENTATIVE"APPOINTMENT DATE._ — TIME <br /> tpiease piva 7 to i0 business days from date at applic,40A aLbmitlil) <br /> © CHECK BOX TO EXPEDITE INQUEST-$78-00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT` "'�a r� L• � �.rs<o+-f DATE Cn! 1�lcsd <br /> . I <br /> Flt ADDRESS <br /> "t -rxoko -m.�%CA EA 3 s o- <br /> L <br /> f <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Ga UKQEgGROUND TANK JUST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Cl SOUP WASTE FACILITY <br /> W OTHER CLEANUP SITE(NOH-LOP) ❑ FOOU FACILITY 11 SOLID WASTE VEKICLE <br /> (� UNDERGROUND TANK tMOMITORINWREMOVAL) 0 DOG:KENNEL O 0ARY i <br /> • HAZARDOUS WASTE GENERATOR 0 CHICKF-N RANCH 0 PKG TREATMENT PLANT <br /> • TIEfieD PERMITTED FACILITY 0 MOTEIJHOTEL 13 pUmpF_R TRUCKIYARDICHF:MTOILETS <br /> • TATTOCiSORY PEiftCING 0 PQOLiSPA 0 LAND USE APPLICATION SITES <br /> CI MEDICAL WASTC FAGIt1'y © PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List vp to ten addresses In the space above. Select the typos) of files from the list above by checking <br /> the appropriate boxies). At least one file type MUST be selected. Fax to(249) 464-0138 or mail to the <br /> address indicated-above. <br /> 2. EHD Will notify the applicant if 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 activeiy being worked on by EHO 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 returncd in the same condition 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 $T8.00 deposit prior to review. <br /> 5, "TENTATIVE appointment dates must be Gonfirmcd with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> i <br /> GATE TIME <br /> CONI'EFtMI=E� APPOINTMENT - I <br /> DATE CONFIRMED PHONE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> Ex 00 i{ 41410no <br />