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Jun 05 02 :5 ver Inc 53 42 1490 p. I <br /> 0 401. ENVI AL HEM01 <br /> P xNote 77 j� q^ c�sees► YPUSLIC HEALTH SEFt1+ l LSO <br /> To Tram AL HEALTH DIVISION <br /> co-mw. 0 1co. `` t AVENUE,THIRD FLOOR JUN 0 5. 2002 <br /> pwr"! 71 <br /> TON CA 95202 <br /> Pime r 9)466-3420 <br /> Faxp RELEASE APPLICA�'I UIV1v1EN-t HEALTH . H <br /> APPLICANT r I _� �/EZ�BUSINESSfAGENCY <br /> ADDRESS '�� f� �'7N���.�•��- l—I1.1 �O O �,f-�'/C� G� <br /> PHONE S 30 - 3 IMILE 3t7 - n <br /> TENTATIVE*APPOINTMENT DATE 0 • TIME <br /> (Please 9ws 7 t 10busIn4fis days from goof appil i s 't <br /> CHECK BOX TO EXPEDITE REQU ST-$69.00 FEE-REQUE OCESS IN SINE S A 04 <br /> SIGNATURE OF APPLICANT r DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS G • <br /> 313 ! A "7U `r` CR ' ST-OGk k~. j <br /> P-co• 3 5-1 Y f-JAM tf M LN E-• CP-- rJ `L <br /> 1611i IVLII., <br /> ENVIRONMENTAL HEALTH DIVISION FILES 1 2002 <br /> X'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ® SOLID WASTE FACILITY <br /> A OTHER CLEANUP SITE(WON-LOP) <br /> O FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> ZAZARDOU <br /> NDEROROUND TANK(pAONtTORINGIREMOVALI d DOG KENNEL CJ DAIRY 1.S WASTE GENERATOR Q CHICKEN RANCH n PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTELIHOTEL C] PUMPERTRUCK/YARD/CHEM TOILETS <br /> TATTOOIBODY PEIRCING O POOUSPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM C] OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses to the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At(east one file type MUST be selected. Fax to209),484.0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any END tiles exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days atter receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be.scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by END Staff may not be immediately available for review. A new <br /> application maybe submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expanse <br /> ar the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> .6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. � TIME <br /> DATE CONFIRMED PHONE FAX :INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />