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11 / 7 0 / 2003 16 : 30 464013iu ENVIRONMENTAL 1- <br /> CEIVirQ p d 7 PAGE 02 <br /> SAN OAQC) N COUNW EHD LOG NWMEtEK <br /> ENVMONWNTAL HEALTH DEPApTMFNT <br /> NOV <br /> 304 E Weber Ave Yd Floor Stooktora, CA, 95205 <br /> 20c 9) 4683420 Fax : (209) 454-0138 Web : www.coaSUmjoaqummus/ehd <br /> mus/ehd <br /> MPFRMIT/3E J HEALTH pTJLLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - t c1T'�y1 Cr1 1�" 1 vis rr eUSINE$ SIAGENCYt �. �E ( e C}✓l $ tl-( � -� <br /> ADDRESS; Cot + . t �tq I) la b MOS G �C 2DoLk) t` G>r� ' C ri <br /> HONE: -- Lis Z- S$ 6pda }c ld !�' FACSIMILE ' . 1F2-� LcbS 6p6 ?� ( <br /> TENTATIVE" APPOINTMENT DATE : 1 17 Time: 110 ,000 <br /> (Please allow 10 business days from date of application submiml) <br /> CHECK BO)( TO EXPEDITE REQUEST - $9 . EE EQUEST PROCESSED IN a BUSINM DAY$ <br /> . SIG7NATURR OF APPLICANT DATE ID D <br /> Department Uso Only <br /> FILE ADDRESS UNIT <br /> Zly 9 o r Iva chy c <br /> z srro� r 7-5 'v�.t fZ i) cI r✓�. ❑ Unit 1 <br /> 13 76 Alv Te r <br /> Lmac6 a A <br /> 4. C1 Unit 1 � "� �� <br /> 5. fte9t 6q`'` 5 24 1 ' a G <br /> s. sero GvtsF G 5 ( ,- <br /> 7- root ��t 57` s �e" a r;4 CJ <br /> a. sirtrt ray ho I ` r t S fu �ia� � � city . 1 �'�xt 6`1 '5CrP PENN <br /> nit 4 <br /> B. 31t[�l CI <br /> © Unit 5 <br /> M $0[[I City <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> r.3 <br /> OTHER CLEANUP 317E (NON-LOP) n FOOD FACILITY ❑ SOLID WASTE V13HICLE <br /> fUNDERGROUND TANK (MONITORtNGIREMOVAL) D DOG KENNEL El DAIRY <br /> rHAZARDOUS WASTE GENERATOR M CHICKEN RANCH M PKG TREATMENT PLANT <br /> TIERED PERMTITED FACILITY C3MOTELlH011 1L 13PUMPER TRUCK/YARD/CHEM TOI <br /> TATTOO/BODY PIERCING ❑ POOUSPA Ci LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY C3 OTHER (PLEASE SPECIFY) <br /> 7 . List up to ten addresses in the space above. Select the type (s) of files frorn the Ilst above by checking <br /> the appropriate box(es) . At least one file type MUST be selected , .t=ax to (?091 �4e_4.0138 or mail to thg <br /> address Indicated above. <br /> Z , EHD will notify the applicant if any EHD files exist. An appointment for review will be conflnned <br /> approximately five business days but nolater than ten (10) days after receipt of application, The files <br /> will be held for a maximum of five business bays for review, Appointments should be scheduled <br /> accordingly. I . <br /> 3. A fife that is actively being worked on by END staff may not be Immedlately available for review, A new <br /> application may be submitted when the file is available. <br /> 4. Any file not Teturned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $4.00 deposit prior to r®view, <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 61 Applications received after 3 : 00 prin will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME � C � <br /> DATE CONFIRMED PHONY FAX INITIALS ' <br /> REVIEWED •A YFES NO REVIEW DATES <br /> Lpqu <br /> E2/20n9 - If� -U � /tl •) „ rL( 5 ( t � t(/1 c �� S `vr `G( <� � � CS� �A <br /> TO 3E)dd Ce,,�e (LAS ) s N inns oO13e <br /> TZT9E8Z9E6 bE : LT E00Z / 01 / 11 <br />