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eJLs6. tee.n � - n t •... i .. _ .. .. ....�..-.... _ -.�— <br /> ' 1. I <br /> lliTE RECENE �DY � Er,a�oG NUMa�n <br /> SAN J��fa- <br /> TYPURLIC HEALTH SERVICds <br /> 1 Qa r TAL HEALTH DIVISION <br /> u uu '�� "-- R AVENUE,THIRD FLOORW <br /> OCKTON CA 95201 � I <br /> -1 NEP (209)468-3424 <br /> ON EN �11�ESPUB�IC RECORDS REL: EASE APPLICATION <br /> I l�Ellll � <br /> Qp `l C'^ <br /> �FPLICANT S� V00 LZINESSlAGENCY Fw'QE <br /> RO QRESS <br /> PHONE � � ~ � FACSIMIL5 <br /> 1 �. <br /> f TENTA-E-ti/E"APPOINTMENT DATE TIME. <br /> (Please give 7 to 10 burin ess nays irotH data*$applicatiop submittal) <br /> CHECK 930X TO=,XP15OrrE F2Epl}ES C- S.DU FEF--RE0UE5YOCI:SSED IN 3 BUSINESS DAYS �} <br /> D.TE ! r Pdc <br /> SIGNATURE OF APPLICANT ^— <br /> t <br /> THIS SIDE=eH rn USF ORL <br /> V i FILE ADORESS <br /> �n21� i n PROGRAM E O+It=NTs 3EARCF{ <br /> I <br /> s <br /> I �f <br /> I F-WIRONME NTAL HEALTH OIVI$ION FILES <br /> UNGERGP.0UWD TANK(UST)CLEANUP SITIE(LPP) Q HOUSING ABATEMENT C] SOLI[)W6-M Fq(at,lTY <br /> SOLID *ST=VEWCLE <br /> OTHER CLEANUP SITE(NON-LOP} FOQDFACiLITY V1❑ DAIRY .' <br /> UNDERGROUND TANK(MONITORINGIRWOVAi-) 0 DOG KENNEL ❑ DAr TR TtIEFNr PtAIyT <br /> FIA2ARDOt15 WASTE GEt1ERAYd12 D CHICKEN F2ANCH <br /> HAZA D F>= 5 WAST FACILITY G7 maltELY140TEL Cl f'tIA7PE 1JC1CIYhAt7�C W TO(i..ETS <br /> AATTOC$SODY PEIRONG 0 PODIISPA 0 OTHV'XLAND U APRLtCAT10N SITE$ <br /> T <br /> ME=DICAL'r�ASTE FAC[L.ITY ?kr'U8t lC WATER SY5TUM O bTkE[2 1 iLEASE SPECIFY A1E301fE) � <br /> List up tO tan addresses in the space alcove. Select the type(s)of files from 'he list above by cher-king <br /> tho appropriate box(esi. At Scant one fiie typ$MUST be selected, F o 20. 484-0 <br /> 38 rn Ll!a the 'I <br /> address indioaled above. <br /> END will notify the applicant if any EHD files exist. An appointment for revic f will be confirmed <br /> { <br /> app fivo busirte s days but no later than ten (10)days attar r&Ceip'�;of Oppiiration. The files <br /> will be held for a maximum of five business days for review. Appointments.4hould be, <br /> accordingly, <br /> A file at' actively bin on e worked by EHD staff may not be 1mrmetliately;,wliable forreviiew. A new <br /> application may he submitted when the file is avaitabie. j <br /> q, <br /> ed iii the same condition as released will be r"rgan <br /> Any file not return Ui f C=ND staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$7E.00 deposit prior to review. <br /> 5, •TENTATIVF, appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed the ne%t business do <br /> a� <br /> TCO)NfF: ''NEE-[) APPOINTYMENT DATE TIMI: <br /> PHONE FAX IN JALS <br /> GIATE CONFIRMED 1 <br /> I EVIi:WED YES NO REVIEW DATE <br /> TQTAI. P.02 <br /> I <br />