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ly- -Lr1 vu. b _ N LAL� •. - l.:-t_. <br /> tiB-17-'2091 k';7'213 ROhI Tr 17074-4 6 49 L�5 <br /> SAN JO-04U1N COUNTYPUCLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 504 EAST VVESER AVENUE,THIRD FLUOR <br /> STOCK)4N8-A25 <br /> i 171001 <br /> PUBLIC; RECORDS RELEASE APPLICATION <br /> SL'SINESSIgGENCY <br /> ! <br /> APPLICANT ����� I,t)C.�:�� 1 r�Fn-1 L.- I A C <br /> PHONE -I p',.-___L.1 f� �FAGGI7.•ItLE� � =. ry- ©E`_ <br /> TENTATIVE"APPOINTMENT DarE TIME _ <br /> (Pisa"gave 7 to 10 busiaes=Y;from hale orappticauon OuhmlUaly ^' <br /> UVIF5 31 <br /> CHECK e0X To EXPErri-F ReQu gal REQUIE TPROCFS-SE:) 7 OUSlNESS DAYS / / <br /> SIGNATURE OF APPLICANT DATE -�`.C��.L.�� <br /> FILe ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEAR011 <br /> rrD `Y. LOJ7l CA 1 <br /> SDI <br /> A <br /> iv-i, <br /> - yi �.._ Leal erk <br /> 2Z W oy a�/ tC VA I <br /> 'ENVIRONMENTAL HEALTH DIVISION FILES <br /> 16 UNOERGROUND TANK(US q CLEAN-JP SfrE IOP) 0 HOUSING ABATEMENT 0 SOLID WASTE PAcIt..ITY <br /> OTHER CLEANUP 51TE tNoN•LOP) d FOOD FACILITY In SOLID WASTE VEHICLE <br /> IUNDERGROUND TANK(MONITOKINCtREMOVAL) G DOG KENNFL r? DAIRY <br /> HAZAROQU5 WASTE GENERATOR L7 CHICKEN RANCH ❑ FKG TREATMENT PLANTTIERED PERMITTED FACILITY ❑ NIOTEUHOTEL C7 PUMPER TRUCKIYARDICHEMTOtLETS <br /> TATTOOin DY PE(RG1RG O POOUSPA U LAND US E APPLICA RON SITES <br /> ' IIIEDICALWASTEFACILIrY ❑ PUSLIC'NATZRSYSTOM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(S) of fifes from the list above by checking <br /> the apprOprialc box(ea). At least one file type MUST be saiocted• Fax to (209) q6q-0'136 or mail to ILE <br /> 3=rass indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will ba Confirmed <br /> approximately tive business days 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 Mview. Appointments should be scheduled <br /> accordingly- <br /> 3. <br /> ccordingly- <br /> 3. A file that Is actively being worked on by EHU staff may not be Immediately available for review. A new <br /> appitcation may be submitted when the fife is available. <br /> 4. Any file not returnod in the same condition as released will be reorganized by EHO Statf ilt the expense <br /> Of the applicant. Future file'reviews by the same applicant may requiro a $67.00 deposit prior to review. <br /> 5. *TENTATIVE appo(ntrnent dates must be confirmed with EHD Staff. <br /> 6- Applications received after�3:00 prn will be proco5sec the dead business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED •_ PHONE FAX INITIALS <br /> REVIEWED YESNO. .� REVIEW DATE <br /> TOTAL P.01 <br />