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ENVIROFIENTAL HEALTH� PAGE 01 <br /> e� �0�4 50 4640138 tnu Lw Numaert <br /> )p R OFA <br /> A(s J J LE DD SAN JOA,QUIN COUNTY <br /> MAY 1 1 2004 ENVMONNTNTALHEALTH D>;pARTMENF g/3 <br /> 304 E Weber Ave 3`�Floor Stockt�nS�C a9$agwn,ca us/ehd <br /> ENVIRONMEOMpL43420Fax: (209)4.64 0}38 Web:w�"+�v <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> P � <br /> :rSA n4APPLICAN � 1j; � BUSINESS <br /> uslNEssGSek C4 7,%9'Z <br /> 64 <br /> ,%9'L <br /> rSv,krODRESS: <br /> 3� �2 __ fACSIWLA, O_ L &-400 <br /> Q <br /> �—PHONE• Np:OD - <br /> a b-.• 11 �o d}Pd✓lP <br /> Time: --- <br /> TENTATNE"aPPOINTMeRT DATE:�. <br /> (pleas@ allow to business days f,,M data of application subMit=3I) <br /> ❑ HEDATE CK BOX To EXPEDrrE REQUEST 593.00 FEE-�RE FST PRI ED IN 3 BUSINESS DAYS <br /> C5_ l"'0qAf <br /> SIGNATURE OF APPLICANT De('artmem Use Only <br /> jUnit <br /> . FILE ADDRESS Sa t toI 5, W-1 W 56k <br /> c <br /> p, 9eeel <br /> ' 70. SOvel <br /> DEPARTMENT FILES <br /> ENVIRONMENTAL HEALTH p SOLID WASTE FACIOTY <br /> U3 CLEANUP SITE(LOP) O HOU-UNG ABATEMENT ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK( TI [:3 FOOD FACILITY p DAY <br /> UNDERGROUND SITE jmpNi{TORINGIREMOVAI.) p DDG KENNEL ❑ PKG TREATMENT PLANT <br /> UNDERGROUND TANK(M ❑ MOTEL OTEL p Ijam R'rRUCKIYARD7CHi:A1•NILETS <br /> F p tpouS WASTE GENERATOR p MOTELtkIOTEL p �7D USE APPLICATION SIZES <br /> ' ❑ tlE1tED PERMITTED FACIL" �❑ poouSPA <br /> ❑ TATTO0IBODY PIERCING p OTHER(FLEE SPECIFY) cheaklnA <br /> ❑ MEDICAL WASTE FA.ca m s of files from the Itst above by <br /> At(east one file type MUST be selected. Fax to z09 464 0138 or mail to the <br /> (• List up to ten addresses In the space above. Select the type{ <br /> the aPPrOPHate boxes}. <br /> address lndicatad bove. F}fD files exist An appointment for review will be lon. T Confirmed <br /> EHp will notify the applicant rf after receipt of appile sc;ho The files <br /> Z. � ointments should be schoduled <br /> approxlmatety five business da but nv laterthan ten {10) ays <br /> will be hold for a maximum of five business da for revleWb�mmediately available for review- A new <br /> accordingly en by EHD staff may <br /> 3, A File that is actively being worked. <br /> SO <br /> application may-n submitted when the fl condition is avaeasilable• uire a$93.00 deposit prtor to review• <br /> 4 Any fila not rotul in the same the as resame l applicant may req @rued 3.EHD staff at the or en <br /> of the applicant Future fife reviews by <br /> 5. eTENTATNF.appalntment dates must be Confirmed tdha ext business day. <br /> G. Applicatlons received after 3:00 pm will be processed <br /> TIME <br /> CONFIRMED APPOINTMENT DATE PHONE FAX INITIALS <br /> DATE CONFIRMED REVIEW DATE <br /> REVIEWED <br /> YES NO <br /> Emu ea.�L06. <br /> 0/10 39ti8 - <br /> dI-1vo ON snivais 90099L90E9 917:4T 600Z/TT/90 <br />