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uafE R�N�❑ <br /> SAN JC IIN COUN'lTYPUBUC HEALTH SF -'vES <br /> IRONMENTAL SI\I <br /> 304 EAST WEBER AVENUE,THIRDFLOOR <br /> STOCK? C 9 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ADDRESSrl //7 <br /> PHONE �f �Cr� {i'!� C}� FACSIMILE ���/ � <br /> TENTATIVE"APPOINT Ia4T DATE T1MF <br /> (Please Dive 7 to days fr dntc of appiic-%vbn submlt[aDrift Ift2vaArgift <br /> �iU r fiS ,� �313USINGSS � 2001 <br /> EDCHECKPox To 1 PT-DITE'REQUEST-S78.o0 FEE--RECUEST PRO8 SSED, DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> O <br /> 1041- "evf <br /> N � <br /> V1 <br /> —1� If 01111 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> OCT 2 2 � p� <br /> UNDERGROUND TANK(UST)ci-gANUP sn-r--(LOP) O HOLISING ABATEMENT SOLID WASTE.FACILJ rY <br /> OTHkH CLEANUP SfCE(NON-LOP) Q FOOD FACn-ITY SOLID WAS-M VEHICLE <br /> UNUErRGROUNV TANK(M0NtT0VJX REU0VAL) O UOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH TKG TREAT"(E0 TIEREDPERMI7T✓:DFACILITY o MOTELHOTEL UIdPERTRUGir3aCJTATTOOIZODY PEIkCING C] PpOLISPA ANDUSE APPLICATION SITESEPtCRt WASTE FACILITY ❑ PUBLIC WATER SYSTEM Tii_tip <br /> t(PLEASE sYEC1FY AI30YE) <br /> f. Liat up to ton addresses in the space above. Select the typo(s) of files frd Ist a checking <br /> the appropriate box(m;). At feast one F]e type MUST be selected_ Fax t 7- 4 f3S o it to ft <br /> ,ddrgs�s Indicated above <br /> 2. EHD will notify the applicant if any EHI)files exit, An appointment for review will be confirmed <br /> XupproXimately five business slays but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for re-view- Appointments should be scheduled <br /> accordingly. <br /> 3- A file that is actively being worked on by EHD staff may not be immediatoly available for review. A new <br /> aPOCation may be submitted when the file is available. <br /> 4. Any•file not returner) in the same condition a$released will be re-organized by EHD staff at the expense <br /> of the applicant_ Future file reviews by the same applicant may require a $73.00 deposit prior to review. <br /> 5. 'TENTATIVE appointtrlerlt dates must be conni-ne i with EHD staff. <br /> 6_ Applications received after 3-00 prn will RIB processed the next business day. <br /> 1 CONFIERME-0 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE rA)t INITIALS � <br /> 1 REVIEWED YES NO REVIEW DATE <br /> Em vu +• o+.ystgo <br /> TUTAt- <br />