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06/27/2005 1.0:50 FAX I <br /> 0 043 .+ <br /> DATE REGEIYED 3. EHD LOG NUMBERI <br /> SAN�oAQvnv COUNTY <br /> ENVMONMENTAL MALTH DEPARTMENT _ <br /> 304 Erik Weber Avenue,P Floor, Slocktab,CA 9524?.-270F <br /> 37 <br /> Telephone;(209)46$-3420 Fax;(249)464-413$Web: www.sjgov.org/Ehd <br /> i PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: " BU5INESSfACsENCY: 4c.1 <br /> ADDRESS: A� y <br /> FHONE(2): AC3IMILE:LL!—No la-44, T <br /> TENTATIVE*APPOINTIVIEW DATE: rome; <br /> (Please allow 10 business days from date of aper -djon Subr[*lal-*)-alTfadw only-must be con$irrried) <br /> [D CHECK SOX TO EXPEDITE REQU -ti43.Q0 F ( H R CHECK ONLY)-REQUEST PROGESSEM INS USINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE <br /> UNIT DISTRIDLMO 0 Unk Unit 2 0 Unit 9 E3 Unk4 Q Unit 5 ❑ Unft 5 ❑ E7tfrer(e[eclrvnitJlrStsJrrtdp,) <br /> FILE ADDRESS: �. EHD USE ONLY <br /> 5traet# Strut Name Clly <br /> 24. <br /> _. <br /> 7g - - - <br /> 10. -- <br /> Specific Date Pang of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UND:RGRoumo TANK(UST)CLEANUP SITE(LOP) Q Howmr.ASATEMENT IM Souv Wa see FArAuTYNerllcL:E <br /> Q OTHER CLEAHLIP$TEE(NON-1_012) Q FOOD FACILITY ❑WASTE TIRE <br /> 0 UNDERGROtM,TANK(MoNrMMNGn:X MOYAL) fl DOG IOr-NNEL 1WRY <br /> 13 HAzARoom WAsm GENERATOR O CNIC?MN I MCH ❑WAsTEwATER TREATNEENT PLANT <br /> TIMM FOUETTEEI FACILITY ;.Q MOMLIHOTEL 10 PuPAPERTRUCKIYARDICrmEY!TOILETS <br /> d TAT rWA 30DY FlZROING ❑POOLISPA E3 LAND USE APPLICATION SITES <br /> Mr ttcAL WASim FAGIL rrY 17 OTHER JPLEASE SPECIFY) <br /> WO-L AND SEPTtC PERMrr REOOP10$ARF;AVAILARLE FOR REAM- MONDAY-FRIDAY 0.00 AM 5:00PM - FXCL.UaING HOLIDAY& <br /> 1. ust up to ten addresses In the space above. Select the type(*)of files from the Tisk above by checking the j <br /> appropriate box(es). At(east one file type MUST be selected. Fax to(209)464-0138 or ma ii to the add ress <br /> indicated abovs. Address ranges will not be accepted—for additional assistance with file addresses,confect <br /> the EHIO.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD vrill notify the applicant if any EHD tiles exist An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> hays for review. Appointments should be'scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review, A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file review by the same applicant may require a$53.00 deposit prior to review. <br /> 4 <br /> 1M4tl6 <br /> r <br />