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I v I`Jv�t,AI N.U2 <br /> DATC Ae�cevto / � �- tiru..w",w-- <br /> a -- ' SAN JOF 1IN COUNTYPU13UC HEALTH SER' wES <br /> E*VIRONMENTAL HEALTH DIVISION <br /> 304 EAST WF-SER AVENUE,THIRD FLOOR /MVION ®� <br /> STOCKTON CA 05202 <br /> IVI;AR 16 2000 (209)468-342.0 mi <br /> ENV' -;c-ALPUBLIC RECORDS RELEASE APPLICATION <br /> (^ J <br /> PL Y• BUSIN4=AGCNCY Gt}�—G• q � C•C� <br /> ADDRESS <br /> PHONE l Lp z� ) ([iC��C1� FAgtMLE �f <br /> TENTATIVE'APPOINTMENT DATE TWE <br /> (piaaae give I to 19 businoss dzys from data or apprlcagon subftaw) <br /> C}{EpC 807(To EXPt_DSTH RE75T :�—_RC�E �PllD W](3U3HiE9S DAYS <br /> SIGNATURE OF APPLICANT DAYS tDQ <br /> VA <br /> FILA ADDRESS <br /> � Q <br /> I <br /> L2-r-�s-•-faycJ O <br /> ENVIRONMENTAL HEALTH DMSto(y Ftl.$S C M e. - I--V&- —� <br /> ❑ UNDERGROUND TANK(UST)CLeAKUP SUE-(LOP) O HOU5INGAZATEMENT <br /> D FACLUTY❑ OC3 SOLID WASTE¢AWtJTY <br /> TIIiI:R CLF_AtlUP St"(NUM4-0F1) n <br /> ❑ UNPERGRQUND TAxx(M0Nff0"GMFM0VAL) ❑ pDOG K" EL 0 SDAAI Y Vf/I►g7)=w£HICI E <br /> ❑ HAZARDOUS WASTE GENERATOR D CH)CXEN ft HCH � <br /> 17 TIED PER"TTED PACKM PKQ TREATME-:N'r PLANT <br /> ❑ TATTOOMODY PEIRCING D PQOLMPAA7E1. a PUMPER TRUC1QYAROm.Hr; -r0 X.M <br /> C7 ML°DICAL,WASTE FACILITY PUt3uC WATER 9YSTEM `Q-�GAMD USE AFPLJCATION 8nn <br /> THBR(PL.�JIq>;SPPCF}(,RBL]YE) <br /> 1. List up to ten adt3rlessQs in the space above. <br /> the appropriate Select the types))of files from the fist above by checking <br /> box(es). At least one file tyP*MUST be se(acted. Fax to{203)4�4-01' <br /> addresp indlGa(gd -bad or mil tQth <br /> 2- EHD wpl notify thapplicant if any EHD file$exist, An$ <br /> approximately ltvQ twslness days but no later than no d <br /> ten(Tp�day� for <br /> ��tpt o�1pp,I catior►mThe fifes <br /> will bo hold for a maximum or five business days for revi*w. Appointments should be scheduled <br /> accordingly, <br /> 3- A filo that is actively being worked on by EHD staff may not be trTlRtedlatgiy avall$b1e for review, Anew <br /> application may ba"Ubmitted When th*file is available. <br /> 4- Any file not returned In the s>a nl*condition as released Will be reo <br /> Of the tippilcant. FtlturQ file reviews by the same roanized by EHD stafT at the expense <br /> S. <br /> 'TENTATIVE a applicant may require a$7$.40 deposit prior to review. <br /> Ppointl�l�nt datRs must be contirttled vNttt EHD staff. <br /> 1 RpPllcations received after 3:00 pm will be Processed the next buslnosG day. <br /> COf FIRNIE4 APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED NO <br /> REVIEW DATE <br /> f <br /> TOTAL P.Rj <br />