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Z001 <br /> 10/19/2004 16:14 FAX 6439049 , <br /> -- - --- - SAN.90AQUINQ-,OUN'I'Y �--. <br /> 11 ENV7�ONI ENTAL I]EALTH DEPARTMENT <br /> CA 95205 Zo �� <br /> 304 E Weber Ave 3'd]Floor Stocldon, <br /> 2 464-0138 Web:www.co.san jltliio.ca.us/ehd <br /> 2�)468-3420 Fax-..( 09) <br /> PUBLIC RECORDS RDS RELEASE APPLICATION <br /> SUSWESSIAG84CY: t5 <br /> APP�ANT• � . �- Gl� � � <br /> ADDRESS: lkoo <br /> iG � c <br /> PHONE: <br /> l gb x'3413 f ltd —FACSIMILE: <br /> { Tue-.'{ENTATIVE`AppMTD6ENT DATE: <br /> (Ps—se w 10 businaws days ftm date of ai)0-60 sobmttf(Ps—se <br /> © CHEM BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST pROCESSED IN 3 DUMFSS DAYS <br /> DATE <br /> SIGNATURE OF APPL1GAldT Oepartieni use only <br /> UNIT <br /> FILE ADDRESS <br /> 0 Unit 1 <br /> z 11.1 07 in or n Cky - Unit 2 <br /> l0� <br /> 4. sox, 302( 1"LLorrl+vv� i`r: L Unit <br /> a. Unit 4 <br /> 7s� <br /> ad q (] Unit 5 <br /> a. sm <br /> d ,.-:l pEPARTtf1ER1T FILES <br /> �/} 4TQgENT O SOLID WASTE FACILITY <br /> UNDERGRI /] ��©/'Yl�' I '� � CI SOLID VYASTE VE�NCLE <br /> O aTHER co l� �/� Q DAIRY <br /> UN�ZD04 ��o' 4 v" L H ❑ PxGTREATC+IEHTPLANT <br /> f'` O p(aPpt TRUCiuYARDlCHE1 TOitJ=TB <br /> TMRED PE O LAND USE APPLICATION SITES <br /> 13 TATTOOS ►SE SPECIFY) <br /> ❑ ('�WCAL I <br /> ct the type(S)of files from the list above by chsctnng <br /> 1. Li a ' ST be selected. EM to(209)464-0138 or mail to the <br /> th <br /> eco . An appointment for review will be confirmed <br /> 2. EI n n(10)days after receipt of aPpliztion. The Ides <br /> ten <br /> of For review. Appoint�ts should be scheduled <br /> tot- -- ----- -- - <br /> accordingly worked on by END staff may not be immediately avaiitable for review. A new <br /> 3_ A file that is activelY being <br /> application may be submdted when the file is available• nt may require a$93.00 deposit Prior to review. <br /> anized by EHD staff st the expense <br /> 4. Any file not returned In the same condition as released toil reo <br /> rg <br /> of the aP�i:>~ant. Future ftle reviews by the same applicanconfirmed t <br /> staff. <br /> 5. "TTERTATME appointment dates m�wtrlt be be processed the next business day. <br /> 6. Applications received after 3:00 pm <br /> TIME <br /> CONFIRMED APPOINTMENT DA'Z'E INITIALS <br /> PHONE FAX <br /> DATE CONFIRMED REVIEW DATE <br /> REVIEWED YES NO <br /> UND 4a-W4= <br /> aaarm� <br />