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05/08/2003 13:50 FAX 00 <br /> _n..Y�Recuvev — <br /> -- SAN JOA( N COUNTYPUBLIC HEALTH SE:' CE5 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> N',Ay 0 8 2003 STOCK70N CA 95202 <br /> (209) 468-3420 <br /> 7 PUBLIC RECORDS RELEASE APP•LIC:AT1OP1 <br /> APPLICANT ���'"�- 1 4 "� 13USiNE5S4AGENCY�IMV�R• IiJ1� _ <br /> ADDRESS - <br /> q1i, _FACSIMILE qlf. b3� ____ R_ tEC"_1 <br /> �vt' a <br /> PHONE ���}�� � .Zd�S TIME <br /> TENTATW E'APPOINTMENT DATE V�1DLj ' — <br /> (Plaase give 7 to 10 business days from date o}appucca6on subs nittal) l <br /> E REQUEST-$78.00 FEE—REQ OCESSI'_D IN 3 SUSINES 3 PAY,; ` <br /> CHECK BOX TO EXPl:Dfr d <br /> iaA-r� <br /> SIGNATURE OF APPLICANT <br /> F►LE ADDRES; Tl i1S SI C7H F �D:>TAFF USE CINI`C <br /> prZ OGRAM'=LEMENTS SEARCH <br /> Z (,� G l•r <br /> v5 Vj at a4 m — <br /> ., I . 1�( rLs 644fel C/11 3 �. <br /> (A — <br /> 9 I _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> / C7 ::iOlJl>WASTE FAGl1JCY <br /> 17 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT <br /> ❑ FOOD FACILITY 1;1 30LID WA5'CE VEMCLE <br /> O OTHER CLEANUP SITE(NON-LOP) 0 DOG KENNEL 1:1 DAIR Y <br /> 0'UNDERGROUND TANK(MONITORSNOIREMOVAI) O CHICKEN RANCH 1:3 PKG TRIAD M1ENrT PLANT <br /> O HAZARDOUS WASTE GENERATOR p MOTEUHOTEL 1-3 PUMPER TpUCKIYARD/CHEM TOILETS <br /> O TIERED PERMITTED FACILITY ❑ POOUSPA M LAND USF-APPLICATiON SITES <br /> ❑ TATTOOIBODY PEIRCINQ d f'UtdLIC WATER SYSTEM 1-3 OTHER(PL"SE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY <br /> 1. List Up to ten addresses in the space above. select the type(s) of file s from the list above by checking <br /> the appropriate box(es), At least one file type MUST be selected. I � tv 249L 64-0'i 313 or all tom <br /> address lndicatg :_b0ve. <br /> EHD will notify the applicant If any EHD files exist. An appointment for review will be t:onfirmed <br /> approximately five business days but no later than ten (10)days atter m:eipt of appliC;3tion. The f les <br /> will be held for a maximum of five business days for review. Appolnt:ments should be schedu[Qd <br /> accordingly. <br /> 'A"3• A file that Is actively being worked on by EHD staff may not bo IrnrnediabAy available for review. A new <br /> application may bit submitted when the file is available. <br /> 4. Any file not returnlsd In the same condition as released will be re01-ganiZ(id by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant rriay re(:IUire a y7 o� �{ 0 <br /> 5. "TENTATIVE appointment dates must be confirmed with EIiA stat{• a X _ •A) <br /> 6. AppllcatIons received after 3:00 pm will ba processed the next bu!:in�ess da <br /> ' CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX IfaIT1ALS �_ <br /> REVIEWED. YES NO REVIEW DATE: — <br /> em 00 14 uoo J 3. f�� V� P.�� SUIS- <br /> y tin u 4i J I?pfPf �:oI TOTAL P.02 <br />