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10-25-2001 09:14R4 a'i <br /> SAN JO,4QUIN COUNTYPUBLIC HEALTH SeRVICES <br /> 0`i 2 •,,0 D 1 EP+1VIRONMENII•TAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> rl <br /> 3TOCK7dN CA 05202 <br /> _ (209)4108.342D <br /> i G PUBLIC RECORDS RELEASE APPLICATION <br /> IkVPL }tT� G DUSM1ESIVAGENCY �l�>�/� <br /> ADDRESS <br /> PNOtlic_; ` 2:4- 121-R ---rA=NNLE <br /> I TENTATIVIF'APPOINTMENT dATF- *&J0/ Tum ��.,'��,�j• <br /> (P3►w 91.4 mo buAlne.18 days it"data of apFlwatign subfituw) <br /> CHIEPK.BOX TO EXPEDITE REV4-951(- T.00 FEE- OCt:,f'SED iN 3 BUStNess DAY$ <br /> j <br /> --SIGNAVRE OF APPLICANT DATE .OA <br /> ; <br /> FILL'ADDR SE; tas&R EHID STAFF USE ONLY <br /> PROGRAM ELEMENIrs 9EARC!i <br /> a <br /> w71 294ao r4 �-79T-,;L <br /> I : <br /> i ' <br /> ENVIRONMENTAL HEALTH DiV1SIQN FILES <br /> UN04MGROUNO TANK(UST)GLE"UP$(TTI iLAP) 0 HOUSRfGAB,ATENIEHT �$O,lp W#*=FACILITY <br /> OTNt?i3 CLEAIlUf'SITE(NpN.LOP) _LL D FOOD FACILITY b SOU] VWASTE V1901CLIE <br /> 1tRVOGROL7140TANK jM0XrTORtt�lGJRrj4OVAL) O DOO r,5MNEL O QTY <br /> KAZA DOUS WASTE GEt't6RATOft 0 CHMMN RANCH Q PKC 7RFATu9N1r PLANT <br /> O TMAP4 PERAUTCE13 FAICILrrY O U0TELfii01%L l7 PUNNERTRUGKh'AgDIGHENI TOILETS <br /> C7 TATTOOJSODY PEIRCirIG ! 0 POOWiPw O LANO USE APPLICATION$tt$$ <br /> C3. <br /> M80(4L,'WA4TZ I ACtUrrY O PUBLIC wATX R SYSTEM 0 OTUER(PLEASE 8MCWy ABOYE) <br /> 1 <br /> !. ; List up to tern addressee In the space above_ Select the typp(s)of filos from 1119 list above by checking <br /> ' the appropriate 40x(es)• At;least one file type DUST be selected. FIX, (2gM <br /> ' v x{54-0138 ormi!ae <br /> 2• i EHD will notZty the applicant if any EHD files exist. An appointment for raYltw will 134 Confirmed <br /> approximately five bu3invari days but no later than tea(10)days after recelpt of application. Tno filer, <br /> 1 will tie held for a rnaxlmurn of five buoineaa days for review. Appointments should be'scheduled <br /> ;accordingly. <br /> 3, ;A iqs tlia>r is actively being virorkstf on by EHD$tafi may not be irnnurdiatoly tiva liable for roview. A new <br /> appllcatiott may 4e subettittid when the file is avallable. <br /> 4• jAnY file not returned in the 5:On*cOndigon as released Will be rgUrganized by EKV staff at the expense <br /> of the applicant. Futuro Tile�r*Vfewz by the Raine elppiicsnt may require a$87.00 deposit prier to review. <br /> evie . <br /> 5• �'TEN'tATIVE appoitz(rrtent pates must be conflfined with ENI)st$ff. <br /> 8. ;Applications roceiyed attar M:00 pm will be processed tate next business pay. <br /> CONFIRMED APPow-rM <br /> . FN'i'f?At. TIME <br /> DAIS CQp1FlFt1tAED PHONIS FAX INrrIAL.$ <br /> REVIEW ;rip REVIEW DATE <br />