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! 09/16/2003 15:53 9253715.915 GEOCON - 'EAST F14Y PAGE 01/1 <br /> ENVIRoNMEN � ALTN <br /> F DATE RECENED U ii <br /> II SAN JOA.QUI.N COUNTY <br /> L � EN�RONMFNTAL'1UA T D pA T1v�E <br /> 304-E'Weber Ave 3"d Floor Sto&to>;, CA 95205 <br /> S E P 1 6 2003 209).468-3420 Fax; (209)464-0138 Web:www.co''san joagtdn.ca.us/chd <br /> E-WRONME1NT HEALTH PUBLIC RECORDS MLEASE APPLICATION <br /> Pt LHvi 6, <br /> APPLICANT: 2 C{ ' BUSINESWAGENCY: <br /> ADORMS: J <br /> TI=NTATIVE*APP41AIYmvNT DATE: _ —1 . _T1rne; <br /> (please allow 10 baalness days from date of applioatlail subMittal) <br /> C14ECK BOX TO EXPEDITE REQUEST-$93.004111E REQL)Ffft P_ROCeSS D 0 NRSS DAYS / <br /> SIGNATURE OF APPLICANT DATE <br /> Il Degartrnant Use Only <br /> FILE ADUMS UNIT <br /> W 3 sexC d [ Unit I <br /> t C F O / . J yq �) <br /> �JnIF2 <br /> d s O ,0 61,,ri e Avf, <br /> a 5"01 6k& /' &VV it 3 <br /> 6 oil t7 ro l <br /> E oma ec a ' Unit 4 <br /> z .e a <br /> 1 �' /` Cl Unit 5 <br /> �o. '! <br /> ENVIRONMENTAL Hl~A TH DEPAFtI'.MENT FILE$ <br /> Ef <br /> UNDERGROUND'MANIC(UST)CLEANUP$ITP(Lop) 0 HOUSING ABATEMENT !" 0 SOLID WASTE FACIirrY <br /> D OTHER CLEANUP SITE(NON-LCD) Q ✓coca rACJLrry ❑ SOLID WAST%VEHICLE <br /> !~i UNDERGROUND TANK(MONITORINCRIREMOVAR) 0 DOG KENNEL ;`• in PAJAY <br /> 0 HAMDOUS WASTE GENRKATOR © CHICKEN RANCH 0 PKG TREATMIi NT PLANT <br /> G TIM=RERmrrrED FACILITY ❑ MaTiuHOTEL Cl PUMPER TRUCKfvARDICHEM TOUTS <br /> a TATT0cyBODY PIFKC1NI2 Q POOL/SPA it ❑ LAND USE APPLICATION SITES <br /> i 0 MEDICAL WASTE FACILITY d oTHER(PLYASit SPBCIl�YI� - — <br /> yr. <br /> 1. List up to ten Addresses In the space aboVe. Select the type(s)of files from the flat aboye by chatking. <br /> Otte appropriate box(es). At least Dna fila type MUST be selicted: Fax t0 f2os; 4d -0 8 or Mail to the <br /> p dress indicated.abav�. <br /> 2. EHp will notify the applicant if any EHD files ex]GL An appointment for review will be confirmed <br /> approximately five hu4ieess days but no later that;#en(10)days after receipt of application. The flies <br /> will be held for a maximum of five business days for review: Appointments Should be scheduled <br /> accordingly. <br /> 8.' Afile that is actively being worked an by tEHO staff'may not be immediately available for review. A new <br /> application may be submitted when the file is available. iR . . <br /> 4. An file not returned In the some condition as released will.be reorganized b" EHD staff at the expense <br /> Any g Y i' <br /> of the appllranL Future file reviews by the same applicant rrtay require a$93.00 depasit priorto'review. <br /> S.- *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> &. Appflcatfoni received after 3:00•pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT GATE TINE <br /> DATE GONFItiMERPHONE . FAX <br /> INITIALS <br /> RE%n EWED YES NO , <br /> RIrVlElfy DATE; <br />