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.i Ehu LI7G�iUh'kiiYl <br /> ,*MED <br /> L_ . SAN aEdAQUIN COUNSYPUBLIC HEALTH SERVICES. <br /> _ ENVIRONMENTAL HEALTH DIVISION' <br /> 0 L T Z UZ p4 EAS7 STOCK7ON CA 9�202-rHiRD I=i~OOR LfJ <br /> (203)468424 ;1 <br /> .. - PUBLIC RECORDS RELEASE API <br /> 'LiCATIQN <br /> rh�rf l• r QZ-- Blf5lN1=S5rRGENCY <br /> APPLICANT y /_ C', <br /> PHQNE�Ca`q `7 Q 'l 3 ,FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE IIc2tiorn submittal) <br /> (Pli:d64!give 7 to 10 business s Nom date of app ' <br /> CHECK BOX TU E?CPEQTTE REQUEST-i87.I10 F -REQUEST PROCESSED(N 3 6USINESS DAYS <br /> k SIGNATURE OF APPLICANT _. <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> c.4 <br /> ,t <br /> ti <br /> .p is <br /> I <br /> ENVIp.0NMENTAL NF-ALTH DIVISION FILES <br /> I O SOUL]WASTE FACILITY <br /> UNPERGROUNIO TANK{UST}CLEANUP SITE(LOP) 13 HOUSING ABATEMENT In SOLID WASTE VERICL5 <br /> OTHER CLEANUP SITE(NON-LOP} 1] FOOD FACILITY <br /> 13 DOG KENNEL �,� 0 DAIRY <br /> UNDERGROUND TANK(MOr•IMFUNGIREMOV, Q CHICtCEN RANCH d pKG TREATMENT PLANT <br /> KAZARDOVS WASTE GENERATOR p 6tO�rEUFIOTEL S� �E3 PUJAPER TRUCMAR=HEM TOILETS <br /> ❑ TiERE^D pEFtmiTTED FACILITY O LAND USE APPLICKnON SITEa <br /> D jA ITOpIBOAY PEIRCIIVG pL G WATER SYSTEM;� d OTHER(PLEASE SPECIFY ABOVE) <br /> 17 MEDICAL VIASTE FACILITY <br /> i, List up to toft <br /> addrosses in the space above. Select the WPM Of files from the list above by rhecking <br /> the appropriate box(es). At least one file type MUST be selected. � ax 209 +t6 -0138 or ail to <br /> a i ed ress[ndabove. I <br /> 7, Elia]will notify the app!lcanE if a SEHD files but o lair thars eri(ist An Qj3 days aft ointmenta ercellp of will be <br /> files <br /> approximately five business tfay <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accQrdingty. ot be immediately available for review. A neW <br /> 3, A file that Is actively being worked ort by END staff-may n <br /> application maybe submitted when the file Is available. tj by EHD staff at the expense <br /> nize <br /> 4. Roy file not returned In the same conditthe solos appas li arta may r�pul be ➢re a87.D0 it prior to review,. <br /> of the applicant. Future file reviews by <br /> 5. 'TENTATIVE appointment dates must be corLf processed th@ ed with ND bus(rless day. <br /> 6. Applications received after$:Ola pm will be p p <br /> )TIME <br /> CONFIRMED APPOINTMt=N�DATE :s <br /> DATe CONFIRMED <br /> PHONE FAX INITIALS <br /> REVII�NED YES NO REVIEW DATE <br /> Di as u QW04M <br />