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02�QFEB. 6.20034.7 5:37PN019BENWNNENTAL CLAIMS ENVIRO\M NTAL fEPLT�j� N0.303 P.P.21202 <br /> Fl,b tae„yMe4„ <br /> SAN JOENVIRONMENTAL <br /> VIRONMEN AL HEALTH DI LOON vtC�s � <br /> e 304 EAST WEBER AVENUE,THIRD FLOOR I LIN <br /> 0 6 L003 STOCKTAN CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE'APPLICATION <br /> n <br /> ApPWCANT /,, 1� ^13USIKFSSIAGFWCY <br /> insyf2�+ce ld».,P�/ <br /> �� ��T* -- <br /> /� <br /> ADDRESS <br /> PNONQ L�.'••,! "•v y�f".Sr7 G --- FACSIMILC C /� �J GG _�--•-- <br /> TENTATIVE•nnpolNTMN,"rIl"E �fead- Call In= TIME <br /> • '`'-� ( <br /> • (pleue al`ro 7 101 6uilaeas days IrOe1 dAla W PPII4?lla^autxnllWq <br /> Qox TO EXPEDITE REQUFST•509.00 FEE-•REQUEST pROCESSED IN 0 BUSINESS DAYS U n, <br /> CHECK g • / <br /> �] DATE d i ' <br /> *SIGNATURE OF APPLICANT <br /> _�. <br /> FILE ADDRESS PR141S 109 + <br /> OGRAM EI-L-ME ITS 0 ST SEAR N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �1pATEMENT O SOLID WASTE FACILITY <br /> ,)Rt UNOL•R6ROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING 0 FOOD FAC DA 0 SOLID WASTE VEHICLE <br /> OTHER CLCN+IIP Sfl'E(NON•LOp) Cl DOG KENNEL 0 DAIRY <br /> 0 UNOERGROIINDTANKtMONITORINClREMOVAW 0 CHICKEN RANCH 0 FKG'TRETIjIj&RPLANT <br /> HAZARDOUS WASTE GENERATOR 0 MOTFVKOTEL 0 LAND USE <br /> SIM l'OIIETS <br /> n TIERED PERMITTED FACILITY 0 POOLISPA O LAND USE EASEAPPLsATKIN ABO <br /> 0 TATTO WDODY pWFLCING l7 OTHER(PLEASE 5pECIRY ABOVE) <br /> 0 MCDICAL WASTE FACILITY ' of was from the 115t above by elle(Lkirltl <br /> q• Llsl UP to ton addresses in the spgea above, Select the type(r) <br /> the approprlata box(es). At least one file type MUST be selected. Fax to 7 9 40d 01. 3 I�'•�—II to the <br /> address md,Calyd above. P IicaQOn• Tha files <br /> PHI)will notify It applicant if any EHO,files exist. ATI appointmentfor review will be confiemecl <br /> 2' 1 five business days but no later than fan 00)days after fecal t of app <br /> approximately <br /> will be held for a maximum of five business days for fevlow. Appointments should be schedule <br /> accordingly. Starr <br /> 3. appliicatlon may be submbeinitted wham the W0rK0d an fl a"-available not be Immadlataly aXhHDlslaff at the "Onse <br /> 4• Any file not returned ih the same condition as released will be reorganized 9, <br /> of the applicant. Futuna filo reviews by the same applicant may roqulre a 589.00 deposit prior to review, <br /> 5. <br /> 'TENTATIVE appointmont dates must be confirmed with EHD sta <br /> 0• Applications receivad after 3:00 pm will bo processed the next buslnoss day' <br /> Tills - - - <br /> CONFIRMED APPOINTMENT OATS, INITIALS <br /> PHONE FAX 1 <br /> GATE CONFIRMED <br /> REVIEWED <br /> YES NO REVIEW DATE _ <br />