Laserfiche WebLink
SAN JCS IN COUNTYPUBLIC HEALTH SEf <br /> ENWIRONMENTAL HEALTH DIVISION <br /> N �d� 304 EAST SWF_BER AVENUE,TOCKYON CA 95 02 THIRD FLOOR /_ L <br /> (709)468-3420 <br /> P6131-IC RECORDS RELEASE APPLICATION J1. <br /> APPLICANT auslrlE9SlA0EhICYGfrT�i� G,r� <br /> ADDRESS <br /> PHONE T� f �.�� �� FACSIMILEQ �/ � � <br /> TENTATIVE"APPoINEMENT DATE TIME <br /> {Please�iYo 7 IQ 40 bus��ess days ti d1LC of app6c ylon subrifl"T) <br /> UU I I b 2001 <br /> CHECK 0OX TO EXPEDITE VEST-S70.00 FEE--REQUEST PROCESSED 1N 3 BUSINGSS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> " Q GtJ N —101Q 0/Q <br /> VIC-77-Z2 <br /> M GOle.09 <br /> ENVIRONMENTAL HEALTH DIVISION FILES 0 CT 22 <br /> UNDERGROUND TANK(UST)CILErANUP SITE(LOF) C1 HOUSING ABATEMENT501-ID WASTE FACILI FY <br /> OTHER Ct-EANUP SITE(NON-LDP) 13 FOOD FACM TY SOLID WASTE VEHICLE <br /> VtIpERGRdUNU TANK(MOHIT GWEM0VAL) O OOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTEGENERA UR ❑ CHICKEN RANCH <br /> JPKG TREAT""? PLANT <br /> L7 TLERED PERMITTED FACRIYY ❑ MOTFf OTEL PUId 'ER TRUCKIYJViU1GtIf;M TOfLen <br /> ❑ 7ATT4gJE3pPY P1CIkCING n POOLISPA LAND USE APPLICATION SITES <br /> K&;LENCAL WASTE-FACILITY ❑ PUBUC WATER SYSTEM OTHER(PLEASE SPEc1FY As01/!:) <br /> 1. List up to ton add c�--SeS in ills space abovo. Select the type(s)of files fro Ist a checking <br /> the appropriate box(es). At least one file type I61UST be selected. Fax t 464-0938 ter it to t <br /> ci rSS fndlcated above <br /> 2_ EHO will notify tit applicant if any EHp files exist. An appointinehtfor review will bc confirmed <br /> approximately fiv business days but no later than ten (10)days after receipt of application. The files <br /> will be held for.a aximum of 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 b svbmltted when the file is available. <br /> 4. Any•file not retured in the same condition as released will be reorganized by EHD Mfl•at the expense <br /> of the applicant_ uture file reviews by the same applicant may require a $713.00 deposit prior to review. <br /> 5. `TENTATIVE app intment Dates must be confirmed with EHD staff. <br /> 6_ Applications rece ed after 3:00 prn will be processed the next business day. <br /> 3 CONFIRMED APPOINTMENT DATE _-- . TIME <br /> DATE CONFIRMED PHONE FAX INMALS <br /> LREVIEWED YE NO REVIEW DATE <br /> FM oa +• o+rnmo <br /> TOTAL I1.02 <br />