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IRECEIVED <br /> SAN 10A0 Environ mental HealthDepartment <br /> PUBLIC REGORDS RELEASE APP9-]CA-n()N <br /> EWRONW.LNiAL i_.. <br /> PEWIT/SEWCES <br /> EHD LOG NUMBER4 <br /> APPLJCANT, Chft Olsen BUSINESSIAGENlCY-. <br /> ADDREW, 486 LaAki"VaTliley Rd CITy0s-rATDzlpr Wats.-onville, CA 95076 <br /> PHONE j I)-. PHOKE 12): FAX OR E-MA1l_,- mafinusol-sen(-gimail.com <br /> Plena allaw' 10 husiness dqs ftom dale of application subiWttai IDT the records to be ayaiifabTe. <br /> Staff will canta�k I---ange an appol-ntmenit date and time to mview the feq uc5ted rewrds, <br /> SIGNATURE OF APPUCART DATE 11-28-17 <br /> 1, Ust Ig p to ten addresses in uiqlow: Addres-s ranges WILL NOT be anceptad_ elect the type(s) of fjle S from th;E <br /> list below by checking Ole appropriate box(es)- A[least one file type M113Tbe selected" Fax to Il A.644136.mail to th <br />