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I- <br /> SAN Jo JUIN COUNTYPUBLIC HEALTH SER!kS "�• , ��� /�t✓l., <br /> // <br /> 2 E :.���L. < 0. 1��� LTH viwsss0N .� J <br /> 304 CAST WFIBER AVENUE,THIF<0 FLOOR <br /> I 5TQrKT0N CA 9S.2u2 <br /> r i. (205) 4684420 <br /> PUE3L1jC RECORDS RELEASE APPI ICATlON <br /> AQDAE�s aLrf Isp- Far--l`NW- -a-l car <br /> PHONE I ,Ott . '--'�14 PACSWILE <br /> .l"BWATIVE'APPOLKrMLbt'T DATz telae <br /> i (f'Ieasc:grva 7 to 10 hw inaaa days from date of application avh1n9t;a7) <br /> . CHl;ClS 6Q7S TO,LXp' 17fr ftEQUT�$T-- r.OtT FSE—i QUfS3 PfZ SEO RI T"UsiN>=S5 DAYS JL7 n <br /> SIGNAUf�:= QI �IAPI,lCA1l1 DATE �2L7�b�� <br /> i <br /> FLEE A[tt)Rii- s THl5 Slt]E EHO SYAF U;,,CONLY <br /> PROGmkm EIEE&wwrs:smARCH <br /> b <br /> 9 c1 n n <br /> N�4 _ n <br /> -4- <br /> ENVIRONMENTAL HEALTH DIVISION Fll..e5 <br /> Ut+t01~FtGRMND TAAK t'JS_Q GL EMU P.'4 rTFZ iLOP) Q H0U44 CP AUA"TE�n7 30LJ]YrA TIE FACUUTr <br /> 077t$R CI,C�1 vf.511M(NON-LOP) a FOOD FACp.17Y 47 SCUD WASTE VEHICLE <br /> U1840 ROUND TANK f?*OHfTOP.LNG RrA0VALl 0 DOG Lr.ENN>L. 0 DAIRY <br /> OUt wASTF CEME-FATOR Q CHICKEN RANC)i 0 PKG 7KEATMENT PLANT <br /> In I p!AERmrrgn r-Ao..tTY L] p,iO`iEUiii7'[Et. U PUMPER TE VCKJY.ARdUG LM TOILZT.5 <br /> _rA 0(3 BQ0Y P43 MNG [7 Pdouspk 0 LAND U.$E APPLICA'Yn0i SMES <br /> ME�GAL WASTt FAC]LrrY Q PUBLIC WATER SY'WEM Q OTHER(PLEAS$SP€CtFYADavp <br /> List up to ton aodres$es in the space above. Sotect the type(s)of files from the fist above by checking <br /> .the appropriate box(e.)_ At Icast one file type MUST be Selecred_ Fa3 tq (209j 4fk4 <br /> 0138 or rffail to t_ 4e <br /> :addr�s� indl�alQd ,�gpve. <br /> 2 j ElgD will 1-10tilty the applicant if any EHD file's raxist Art appointment for review will be conf"rmeu ' <br /> I .approximately five bitsinms days but no later than tbn(10)days after receipt of appbcatign.•i7te tilos <br /> will b'e holm far a m4ximum of five busintigs days for mviow. AppointmunW should be scheduled <br /> I accordingly_ <br /> 3. t A riic that is actively being worXod on by ZHU staff may notbe bnMadiatuly available fur rcviow. A nvw <br /> applic,Atlon may be submitted when�bg fila is;RvallablQ. <br /> 4. Any fila riot returnod in too (same condition els 17010 OIJ WIN be rearganiza.a by C HO smir at tlla axpensa <br /> of the apptlGAnL Future filo reviews by ttlo same uyiplicAnt may raqulre a$87.00 deposit prior to revigty. <br /> 5_ [ `TENTA`CIV E appoinunent dates must be uonfii"ad with EmD sWIf_ <br /> B Applications received after 3;00 pm will 4e processed the noxt business day, <br /> CONFiRMED APPOINTMENT DATE _ _ TIME <br /> DATE CONFIRMED PHONE FAX WrIAES <br /> RFVIEWEC3 YES N0 REVIEW DATE <br /> � TnT/-y f7 li]I <br />