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DSEP.25.2002L1;12:46PMT640:Aor'QDIS GERAGHTY&MILLER/JSA:RCNMEMTAL ' 'ALTH M0.277 P.1/1. 02 <br /> an arcLtivm <br /> SAN`.-Jo U1 COUNTYPUBLIC HEALTH bERVICE <br /> NMENTAL HEALTH DIVISION Idb <br /> 4 . WEBER AVENUE,THI R <br /> �pl STOC 9 ONN CA 95202 L91.` II `V L' LQ <br /> O D (20 )4684420 <br /> APPLICATION <br /> 11,, II,, PUBLIC RECORDS RELEASES n 2002 <br /> APPLICANT Alar VOLS r.0 BUSMESSJAOFNCY /ti�)S F-Ni\/IRnNMFNT HEALTH <br /> AODRESs /05-0 ilk SW4. 4---- PERMIT/SERVICES <br /> PHONE (S-!e) 233—32006j FAcsrmu S710 2;3 — �2� [ IR , <br /> z 4' krry <br /> • hY .. >:J <br /> 'TENTATWE`.APPotNTMeNT DAT416h <br /> C7 TIME - }- E <br /> (Freese 1 mese fI&EDI <br /> e of Ilchum submittal) <br /> Frr.RtlOUEST- EQUFSTPRBUSINESSDAYS _ <br /> SIGNATURE OF APPLICAN / DA'TE <br /> FILE ADDRESS THIS SIDE EMD STAFF USL ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> d t� <br /> OU (l Lt 1.1 <br /> ✓2 t. w �, <br /> C) it u h <br /> l <br /> -4im 141 <br /> c,/✓ f/04 c. - 2 -02 <br /> NVIRONMENTAL HEALTH DIVISION FILES <br /> tDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTEFAGILI Y <br /> Pva= R CLEANUP SITE(NON•LAP) ❑ POOP FACILITY ❑ SOLID WASTE VEHICLE <br /> 1Y'UTN"OERGROUND TANK(MONITORINWREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 4 CHICKEN RANCH CJ PKO TREATMENT PLANT <br /> ❑ TIEREU PERMrrrFD FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> C1 TATTOOMODY PEIRCING ❑ POOLJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY d PUBLIC WATER SYSTEM ❑ OTHER.(PLEASE SPECIFY ABOVE) <br /> 1. l lst up to ton addresses in the space above. Select the typo(s) of files from the list above by checking <br /> the appropriate box(es). At lust one file type MUST be selected. Fox to (209)4M-013a or m la I to the <br /> address indicated above, <br /> 2. EHD will notify the applicant if any EHD flies exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The fifes <br /> will be held for a maximum Df five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as reieasad will be reorganized by EHD staff at the expense <br /> of the appllcanL Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with FHD staff. <br /> 6. Applications received after 3:00 pre will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> .'x <br /> DATE CONFIRMED PHONE FAX' INITIALS <br /> I <br /> REVIEWED YES NO REVIEW DATE ; <br /> APr s I <br />