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r - <br /> I f� D <br /> 10) 065 14:48 9640130 <br /> 3,0� ENVIRONMENTAL HEALTH PAGE U1 <br /> QUIN COUNTY <br /> �1; �c c'J08 ENv1RONmE TA L HEALLTij DE ARTmE T <br /> 4 T �z <br /> L`r i N �' '" 304 East Weber Avenue,3`d Floor,StoOkton,CA 95202,270 <br /> �p� ?�+Iih4f•?�/i''r`�'clep(tone:(209)468-3420 Fax:(209)464-0136Web:tivww.sjgov.org/eh <br /> PuBliC RECORDS RELEASE"PLICAUON <br /> APPLICANT { ih1 BUSINESSIAOENLY: 17�j <br /> ADDRESS: -7i�- Cn ; IU <br /> �PHONH(2): �Iu T.,�Z. � 7�j FACSIkILE. L �'f'Li <br /> TENTATIVE*APPOINTM"TDATt9: Zq 8 0 t} Theo: <br /> (Please allow 10 business dpra from date of applloauon submittal--raataffm only.m(at be eenamrad) <br /> C) CHECK$OXTO EXPEDITE FIE $93. FEE(CASH OR CNLCK ONLY)"REQUEST PROCESSED IN:j DUSINMS SAYS <br /> S10NATUREOFAPPLICANT DATE JJYlI'll1S <br /> Electronic lnformaHon: ©List f�Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 9treat# Street NameCity Elunit 1 <br /> �. a, rc uc f, f. <br /> 2. SO rY Nj <br /> 3. ZLa re U <br /> 4. Unit a <br /> 5, <br /> 8, Una a <br /> y <br /> ❑ unit E <br /> B. <br /> g, <br /> Unit E <br /> 18. <br /> Specific data Range of mformotlon Rcquosiud:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT Ft(.1rS <br /> UmmftOROMO TANK(UST)CLEAYUP Srm(LOF) ❑Hdusm AnATrALWT LtrSom WAvre FAoLITY1VrNMLe <br /> OTHER CLEAT"CITE(RON-LOP) ❑FOOD FACILITY "Am nae <br /> UNDUZ14DUND TAIIX(tTDNmDIVHDfRHFMGYAI) 17 Doc KediEL ❑DAIRY <br /> ^&HAZARDOUSWASM GE VMTvu ❑CNNntei RANCH �3.WAVIRWATERTW-VIA NT PLAxr" <br /> O TwRm Poiurreo FACILITY ❑MOTCUHOTEI. O PVWF91RUCKArAWC"cM TUL.ETS <br /> ❑�Ar'mefBeaYPIERCIND ❑PODUSaA ❑LWn U7e ARDUCAr III SM <br /> `�EMED1cA4 Affm FACILITY GT OTHbe(PLr"ii SPECIFY) <br /> WeLL AND SFnt Pgrulrr R"-ons An AYALADLE FOR REVIEW- ROIAAY-PNIDAY 11.00 AM-5:00PM - EYCLUDINO HOLIDAYS. <br /> 1. Lbt up to ton addresses In the space above, Select the types)of tiles from the list above byche"i;the appropriate <br /> box(os). At least one file typo MUST be selactad. lax)',o�Q$1,a&4-0198 ar mall to lha addroes indicated above,_ Address <br /> ranges will not be accepted-far additional aSSi3WMCe wiNl file addresses,confaot tho END.Applications received after <br /> 3:00 pm will be processed the next business day. - <br /> 2- The EHD will notify the applicant If any Ef 0 files exist. An appointment for review will be confimtod apprwdmatafy ten(1q) <br /> days altar receipt of application. The filas will be held for a maximum of five business days for review. Appoinlmonts <br /> should be scheduled aceardingiy. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A now application may be <br /> submitted when the file Is avoilabla. � <br /> 4. Any file not rebirned In the some candifion as released will be reorganized by RHD staff at the expanse of the applicant, <br /> Future fila reviews bythe same applicant may require o$85.00 deposit prior to review.-. <br /> EHD USE ONLY <br /> ernr as avow <br /> TO/TO 315)Vd SINVI-IiSNOO I3]V 66999t,L9L6 CC:IDT eeeai6T/BO <br />