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Jun 05 02 : 5Dn Hr Iver Inc 530 -142 1490 p- 1 <br /> 491st ETAlIROh1.lEMAL HEAL, Q� 81 <br /> Po xNote 71�,. �•• f ;n► YPUBLlC HEALTH SERW L� <br /> prom c.. AL HEALTH DIVISION <br /> GODepl- Co. !AV�NIJE,THIRD FLOOR 'JUN 0 5. 2002 7eZ <br /> TON CA 95202 <br /> �,^�• P�^E 9)468-34200Wv1EN HEALTH <br /> r VP FAX RELEASE APPLiCAl�t <br /> 4 � y -0 <br /> APPLICANT 1 S /' CtPBUSINESSIAGENCY -r v� <br /> ADDRESS ("/,) 'r, C <br /> PHONE 430 — — 3 IM&E nn <br /> TENTATIVE*APPOINMENTDATE 0 ? TIME f7 <br /> IPlesse give 7 i to bust s days from orappllPSIWE <br /> s <br /> SCHECK BOX TO EXPEDITE REOU ST-;89.00 FEE-REQUE OCESS IH <br /> SIGNATURE OF APPLICANT PATE —�! fd •� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 313 1 "rI `'fL C K S -0Ck <br /> 3 Sl H t N E• Cla n) 29 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK NST}CLEANUP SITE(LOP) E3 HOUSING ABATEMENT © SOLID WASTE FACILI•rY <br /> OTHER CLEANUP SITE(NON-LOP) FOOL)FACILITY M SOLID WASTE VEHICLE <br /> f�DEROCtOUND TANK{1110NITORINGIREMOVALI D CHI KEN RA 0 DAIRY <br /> e""AR R WASTE GENCRATOR O C►itCISEN RANCH PKG TREATMENT PLANT <br /> ED PERMITTED FACILnY D MOTELIHOTEL 0 PUMPERTRUCWYARDICHEM TOLLETS <br /> 0 TATTOOIH RMI PEIRCINCI ❑ POOUSPA D LAND USE APPLICATfON SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least on*fife type MUST be selected. Fax to z P 464-0138 or mall 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 /> appoximately fie business days but no ler than n(10)days after receipt of <br /> w lllrbe held foravmaximUm of rive business days for ereview ppoint ent$shou dpbe schedudfiles <br /> accordingly_ <br /> S. A file that Is actively being Worked on by EHD 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 returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the sama applicant may require a$89.00 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 APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX :INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> —xni.rmr -� <br />