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0/07/2004 09:41 CL PLEASANToN 4 12094640138
<br /> hL1.865 D[
<br /> EHD LOG NUMBER
<br /> — 7F J
<br /> SAN
<br /> i; I" �����.. II ,� Ri4ftA'iCUR.tV COUNTY
<br /> ENVIRONMENTAL HEALTH DEPART RENT
<br /> O L T 0 7 2004 304 E weber Ave P k'loor StodIM C.A.9205
<br /> (20
<br /> 09)468-3420 Fag:(209)464•-0138 Web:www_co.$=joa::uin-ca-us/chd
<br /> RV10E5 PUBLIC CORDS RELEASE APPLY/'ATION
<br /> B11SBtESS! "t i'/1ltn y�� '(
<br /> ADDRESS: IA/
<br /> PHONE:
<br /> �1Z S�r l.�.� FACSIMILE'
<br /> � _
<br /> TENTATtYE;APPOINTMENT DATE: -
<br /> (Pkv allow 10 business daps from date of uppoxffion si i Whitt l)
<br /> ` CHECK BOX TO EXPEDITE REQtW.ST-$03-00 FEE—REQUEST PROCESSEDIN3 BUS6N@:i S DAYS
<br /> I
<br /> DATE
<br /> SIGNATURE OF APPLICANT
<br /> DeOMMMIt Use Only
<br /> FUNffff
<br /> FILE ADDRESS
<br /> � 1 CSA` 2 Unit 1
<br /> a Unit2
<br /> to-unit
<br /> s. Sbeet r Unit
<br /> Unit 5
<br /> � saw
<br /> 10,
<br /> to
<br /> f' ENVIRONMENTAL HEALTH DEPARTMENT FILES
<br /> r ' UNDERGROUND TANK(LIST)CLEANUP sim(LOP) ❑ HOUSING ABATEMENT :'�SOLIn w� FACILITY
<br /> C I SOLID WASTE VEMCLE
<br /> MOTHER CLEANUP SITE(NON4.OP) ❑ FOOD FACILITY I:I DAIRY�UNDERGROUNDTANK(MONITOWNGIREMOVAL) DOG KENNEL
<br /> OUS WASTE GENERATOR L9 CHICKEN RANCH t• PKG TREATMENT PLANT
<br /> TIMM PERMITTED FACILITY 13MOTELIHOTEL t PUMPER TRUCKtYAFUDICHEM TOILETS
<br /> a TATTOOIBODY PIERCING0 PO©LISPA r LAND USE APPLICATION SITES
<br /> I'
<br /> Q 'MEDICAL WASTE FACILITY C3 OTHER(PLEASE SPECIFY) - fromheck.
<br /> j 1 x List up to tett addresses in the space above. Select the type(s)of F 3sfii e464-0138 orlist above bin it to theg
<br /> the appropriate box(es). At least one file type MUST be selected. F'„ +n r2no
<br /> address indicated above. ,gym;For review will be confirmed
<br /> 2. EHD will notify the a}�licant if any EHD files An appointmThe
<br /> apprwdmately five business days but no later than ten(10)days aft 1'�e hsps of should sCo u f le$
<br /> will be held for a maximum of five business days for review. Appo
<br /> accordingly.
<br /> 3. A file that is actively being worked on by EHD staff may not be imm a4flately available for review. Anew
<br /> sppiication may be submitted when the file is available.
<br /> 4. Any file not returned in the same condition as released will be mons ' Ued re b F- deposit prior tstaff at the wense
<br /> of the applicant. Future file reviews by the same applicant may req
<br /> g» review
<br /> *TENTATIVE appoints ent dates mast be confirmed with EHD staff.
<br /> gx Applications received after 3.00 pm will be processed the next bust'less day.
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