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rw�c <br /> Rj�,t•IEY GE.(1TECHN1GhL <br /> 81/20!2005 15:01 916-371-1� � ,Q, <br /> \\/ <br /> E,HD LOG NUMBER <br /> JANE d 2005__ - <br /> unv COMM— - ENIH <br /> DATE�MO SAN�Q�Q_-- VIRoN <br /> -- -- $EALTHTiEPART�'� NT <br /> - -- -- ESOT-MvgTAL <br /> - — - ,� CA 95202-2v 0�ehd N{��M)T��CE. <br /> 304 East W giber Avenue,3 Floor,Stockt,a wWwAg° - <br /> tephone:(209)468-3420 Fal.(209)464-0138 R b: 1 v <br /> CORDS LEALSE ,4rPLIC ATION L f A <br /> �O-O 1 G LfM1 <br /> PUBLIC RE I we, <br /> gU51NESSfAGENCT: A <br /> APPLICANT: Vd, wQ FACSIMILE: ' y <br /> ADDRESS: a ( (a D �_O47_.-1--PRONE iZi= — -73G��J�TIR�' <br /> PHONE(1); ._.._�.,.�. _ la <br /> We Only^Meet be ecttatmedl . <br /> TENTATIVL' l+•.."" __.. Q+mm Oats Ct aYP^-• gpeE SEb IN 3 SUSINEsu - <br /> (PIS",ellen' •�u."::... rNCCK OHM.RE+2UEST P• � <br /> 'eticdz:,^" DATE <br /> CHECK gO%TD EXPEDRE REQV S i ti <br /> OF APPLiGANT a Unit 6 ❑ Other iderNO+IdIl3lslmNPei <br /> S(DPIATURE Pt13 Unit• o uttKs <br /> unat C u:lk <br /> ut4'ttxsTRlaunoN EH USE ONLY <br /> FILE ADDRESS. City <br /> v "-- S1ra0L SatRe, Y0.4- <br /> --- <br /> IJ UST H 3. 0 - <br /> V-- <br /> �L(STT 5. "-i GY - <br /> I - <br /> tl. <br /> 7n k "1 <br /> 10 to <br /> ape Date Range of Infonnedon Requested:prom <br /> ^,DNMF.NTAL HEALTH DEPARTMENT FILES . <br /> ❑soO vIO A6ATRNENT O WASTET G'rE FAGLHYIVEIIIFLE a' <br /> WASTE TWE <br /> V�ItjDERGROUNO TANK (NO CLEANDP SmE(LOP) ❑FOOD FACILRY M DIRT <br /> r"Ul, <br /> HER CLDANDP 9rrt(NON-LOP! ❑DOG KRNNEL ❑wA3TEWATEN T,,DATMEtn PLANT <br /> DEROROUND TANK(MONnnNNCJRETrOVIW ❑CNICKEx RANCH in eujepmTRU0KFyAROICHE"roL TaZARDOUS WASTE GENERATOR ❑MOTELMOTEL ❑LAND USE APLIOAnON of" <br /> RMPER/.RTTED FACRen' .-PO"PA <br /> T`001HODT PIERCING O OMER(PLEASE SPECIM <br /> 0 MEDICALWASTE FACKMMONDAYfRIDAT aafa AM3:SOPM ' Fj(CLIIODIG HoL10AT3. <br /> wElL AND SEIRID PERNn RECORDS ARE AVAN.Aat.E Toa ftEMIEw S Of files from the list above by checking the <br /> 1. List up to ten addresses in the space above. Select the tyPe( 1 Ionil dg -0198 ar mail to the addre <br /> appropriate box(es). At least one file type MUST be selected. F <br /> Indicated p ve• Audress ra+•6cs wi!I not he accepted-for additional assistance with file addresses,contact <br /> the 6HD.Applications received after 3:00 pm will be processedolh the next <br /> hcuf reoe�w l'l be confirmed <br /> 2. The EHD will notify the applicant if any EHD files exist. An app <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is eclively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as'e�nseldawill be ire a$93.00 deposit rrrganized by EHD orr to revieff at the P.wx-pense of the <br /> applicant. Future file reviews by the same app Y eq <br /> +n+Ne <br />