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SENT SY: PERSONAL; 925 960 1`144; AUG-12 4:53PM; PAGE 111 <br /> 08/12/2804 14:14 464013b ETM NTAL FAL. s PAGE 01 <br /> DA } ��� SAN JQAQUM C� EPARTNI�N� <br /> D DDD D DD ENvIRaNMNTMALS 2004 . 304 E Weber Ave 3rd Floor Stoc on,CAo tAn.eauslebd <br /> AUG 1.-220 0 4 azo Fgx, (2os)464-0138 Web- o•c�l`j <br /> ENVIRONMENT HEALTH <br /> PERIGI4TJSERVICES 'UREIC pECURDS RELEASE APPLICATION <br /> aukY1 EUS1H£s�rAct:N = . <br /> ADDRESS: 61, <br /> f:AcsIMtLE: <br /> HONE, ��~ Trow: <br /> TENTATIVE'ApPMTMENT DATE= ham date f appileati4naubmlttslf) <br /> (pleas lkilow i4 buSlne9=daN� <br /> �•+� 43.G0 FEt -RBQ I' tN a BUSINESS DAYS r � I— <br /> DePartMant <br /> i--� CHECK a0X TO ExPEor%REoU T- pATE I <br /> SIGNATURE QE APPLICA14T IJT4 use Only <br /> urls* <br /> PttE ADDFXSS � ❑ Unit i <br /> 0 p uvit2 <br /> 2 rAM <br /> s Unit 3 <br /> s, Unit 4 <br /> 6. <br /> g Unit�a <br /> 0. Sam <br /> o. s HEALTH D PARTM�T FILES <br /> ENY1ROl�MENTAL 1iF..A HICLE <br /> FAci+•rnr <br /> ❑ rp�g�G-�TREATVZI`ff <br /> ro wA�VE <br /> CLEANUP SITE tLCf'} MOUSING A9A ❑ "WASE <br /> UNDEROROU140 TANK(03T) C3 FO> FACILrrY C3 <br /> ,OTHER Ct,EMIfP SITE(NOrt-LAP)NG1RE�onlALi C DOG%E"Ei 13 pn`,H II TOt�ETS <br /> UNpgRGRo11N8 TNtK QA0N1TOFn p tHECKEH W tD PUMIPER TRIC Ttaaw g fI�S <br /> [] N tiOUS wAM GER6RA�R ❑ x107�iL1 TEt LAN,Us>"gPVI_10A <br /> © Yi�tl PERMTE FACILIf Y p to4u5PA <br /> U TATT04lR��ltCING <br /> Ll OTIl1=R tpI.EAB SP7:CIF'C} ctteckin9 <br /> ❑ Mes?1CAI.WASTc FACILITY the tYl �s�of ales from the 841 a B or M i a the <br /> e MD be selected. ax t0 <br /> 4. <br /> List up to tart addSI�1®est as�e�fila typ Se e <br /> the app„ priate box(es)- intment for review will be cOn imtTd Cites <br /> add e a y after receipt of applicatio <br /> n.add <br /> will not Ky the applicant if an but <br /> n dies exlat. to aI0 d IntMents Should be scheduled <br /> Z' $pproxlrn2ltely Eye business days but qa inter thsi �movie nr. AP” <br /> wIII be IN*ld#or d rnaximurn of five buetnass days sdiatolY livailable for revlaw- A new <br /> EHD%ft may no <br /> l�itrtm <br /> .e�ardinlyiY• being Worked an by EHp staff at ti+e��nse <br /> 3. Anile that is actively a fila is ova lsble• anlxod by slt prior to revieW. <br /> appiiaAtlon may be sutomltted when the sodrequire a t9s.80 dope p <br /> �carlt fr►aY <br /> Any fila not re In the 19 s.by the sarnel ppI• h vo staff- <br /> of licant. Futuro fi with <br /> of Hta tlpp a ointrrtent dates must 6e confirm ad the next business daY- <br /> 5. <br /> .TENTATIVE pP r 3.80 pm will be prone <br /> 6. APpliGatlotta reoeiwed efts 11MF- <br /> NTMEW DATE INITIAL:-$ <br /> CONSIM-D APFbiPk1I0 HE FAX <br /> DATM CONFIRMED REVIEW DATE <br /> YES NO <br /> REVIEWED • <br /> • avv <br /> &maw <br />