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45.]—eti"GY.i3 1vJ lJ�-11.,11 rr� o.; • :.41��_'�aiu�u r.k;� <br /> ....y.w ••^uxc r.aet:n <br /> SAAB JOAWIN COUN YPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION v <br /> \/�� 304 EAS YJi CK ON CAE,THIRD EtOOft � � ` -50/ 1 <br /> a N`, \ i z u ;_'0 O 1 sTaclaon CA sszaa t t� U1 5 1�Jl <br /> {tog)40@.5620 <br /> ALTH POBLIC RECORDS RELEASE APPLICATION <br /> u�LILC. <br /> ✓"7G tlYSafEEa/AOaNCY <br /> r PHONE Z FAQ-wui c C? — c) <br /> TENTATIVL"ApP48Fre ENT DATE U Um W I I C 3 <br /> ;(PWase ytw 7 m 10 from tlatr of appacctiEn l) <br /> CHaCK am ro EXPEErm 7-S87.0o ED N 3 Buamm DAYS <br /> SIGNATURE OF APPLICAAIT , �_ DATE 11444 <br /> 44 !2 <br /> F TNW ax CFm OTMW vee ONLY <br /> PW06RAM ZLENSM XEARCK <br /> ENVIRONMENTAL HEALTH DIVIS)OM FILES <br /> UKDOWROUND TAUK NOT)CLEANUP WM(LOP) 0 faWSWOASATMM G SOLD WASTE FAtDLr11' <br /> oT1?mG.FANUPBETE(NW4AP) ❑ FOOD FAMM 0 SCUD WASTEVEHCU <br /> UWo=RW14o TANKC C06i KROWL t7 DAIRY <br /> HAZARDOUS VM3TG QkNERA1r* ❑ c"KnOIH IMCH ® PNO TREATW-ur PIAmr <br /> ❑ TIS PERUffM FACIM D morn w4lyL G PUMPER TRUCWYAMCK M TOL&n <br /> ❑ TATTOCATCDYPIMCM D FINN r A .._ .. 0 LAND L=APPUCAT asi, <br /> G• IAADtCAL WASYE FAGLITY - ❑ PL%=WATER 3YUTM 0 OTKM 9%fAU=WGWTA69M <br /> 1. Uat up to ton addresses In the spar:®abava. 841410 the typa{s)of files from the Ilat awe Dy C usWng <br /> ttia apprviKiate bo i(ea), At(east One 11118 type N 13T be selected. FAA 9t24ti1404,0133 or mall to The <br /> address krdlcat aizava <br /> 2. EMD will notify the*ppltraM if any END fRsa"sL An appalntnAent for review will be oenFinnod <br /> appraxhnataiy five business-days but no later titan ton{10)days afW MOW of applltafdon.,The Atlas <br /> will ba hold for a maximum of five business days fur review. Appv-atT Wnts alwwd be scheduled <br /> apcurdilvly. <br /> 3. A fQm tfiat Is actively belnd worked on by END staff may not be i.r+medb4sly Wait We for review. A new <br /> application may be sutintttWd when the ftle Is available, <br /> 4. Any flle not f"".etd In the sags Cundttlon as roteased WUI be raorpanDad by RHO staff at Dim esxpinse <br /> of the applicant Future file rsvlaws by the same appl)csnt may raluire a 507.00 deposit prior to nrview. <br /> S- 'TENTATIVE appoltfknent dataa mutt be ecnfirmed with EHIl staff. <br /> 6. Apptfcations rwe8lved after&DD pm wail ba processed the next buslneaa day. <br /> CONFIRMED APPCW11AENT DATE TWAU <br /> DATE COWL MW PH ME FAX INrnAL8 <br /> REEVIEWSO YES '. NO PEVLZW OATS <br /> TOTFL P.01 <br />