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,FRGi 11 I `A Env i ronmen to l PHONE NO. : 209 369 4228 Jun. 1.1. 2003 11:0 D N P2 <br /> Ne <br /> SAN J6--;QUIN COUNTYPUBLIC HEALTH a4-�VICES <br /> ENVIRONMENTAL HEALTH D1VIS10N <br /> JUN 1 1 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKION CA 95202 <br /> !.AVIRWVENT HEALTH (;09)468-3420 _ <br /> PFRMITiSERV PUBLIC RECOWS RELEASE APPLICATION <br /> APPLICANT T,� /C�fTLt! BUSINI:SSIAGENCY <br /> ADDRESS 22. kJ. a-,us4jt 4 ;. '� <br /> PH0NE� �X-7--320 FACSlIA1LE� 9 r `f?Z��_ ' <br /> e ' 4 <br /> TENTATIVE*APPOINTMENT DATE �< l Lt��(-0t—?J-- TIME / �)0 <br /> (Please give 7 to 10 buslnoas dysq from data of applicatiowsubmitt a) '^~ <br /> CHECK BOX TO EXPEDITE REQUEST- EE- QUEST PROCESSED IN 3 BUSINEKS DAY.i �1 <br /> .yam + ,L3 <br /> SIGNATURE OF APPLICANT L /� DATE `• �p (lU ;E�'I �,,,�� <br /> FILE ADDRESS THIN SIDE k HOSTAFF USE ONLY <br /> PROGRAM�Mf_'NTS SEARCH <br /> • •eco Q� 9�� f .� s��_�� � .�. <br /> gooAAA5 <br /> Q 50h 0CL11 <br /> r3 v r J ---- <br /> e - <br /> 00 ► oZ F <br /> too <br /> 0 1M"'tr ter,. - <br /> ENVIRONMI?NTJU-HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT C1 COUr WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLO WASTE VI:HICLI_ <br /> 1r UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOC;KENNEL CI L,A1R1' <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHI:KEN RANCH ci I'KG 1,REn.TMP�fr PLAVT <br /> ❑ TIERED P1=RM(TED 1"ACILITY ❑ Mo"> OTEL C1 I,UMI3I:R1'R1jC;KNARC/CHEt11 TQU.ETS <br /> ❑ TATTOO/BODY PEIRCING 0 PO0USPA CI LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUP LIC WATER SYSTEM C1 OTHE:t(PLEASE SPECIFY Af M;) <br /> 1. List up to ten addresses In the space above. Select the type(s) of files fro.-n the list above by chocking <br /> the appropriate box(es). At least one file type MUST be selected: Fnx to }09 x.84-1138 or mail to the <br /> address indicated above. ' <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment:for re-riew will be confirmed <br /> approximately five business days but no later than ten(10)days after recOpt of application. The files <br /> will be held for a maximum of five busine_s days for review. Appointments shauld be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by iE:HD staff may not be Immediately available for review. A new <br /> application may be submitted when the fit D is available, <br /> 4. Any file not returned in the same condition as released will be reorilanizetI by EHD staff at the expense <br /> of the applicant. Future file reviews by tha same applicant may require a :;89.00 deposit:prior to review. <br /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will bo processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME: <br /> DATE CONFIRMED PHONE FAX' INCfIAI-S <br /> REVIEWED_ YES _ NO REVIEW DATE .- <br />