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<br /> $ANJOA,,QM COUNTY EHD LOG NUMBER f
<br /> F NVIRONMINTAL HEALTADEPARTmENT
<br /> 3
<br /> t. 1 it Weber Ave 3 Fluor Stoektorl,CA 95205
<br /> Zg' 9)458-3420)Parc; (249)464-4138 Web; www,co•san joaqujq,ca uslehd i
<br /> DEC 1 � .
<br /> Y _ PUBLIC RECORDS ]RELEASE APPLICATION
<br /> Ii
<br /> AFrf>i , ;S BUSINESSIAGEkcY: F
<br /> ADDRESS: CA
<br /> PHONE, 20q- I-KL-7-f oc>G. FACSIM11.5; 2,51- ly(" 1112
<br /> TENTATIVE+APPoINTNIENTnaTi�:—f2- z l- q
<br /> (PleaGG allow 10 hustnese days from date of application submittal)
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<br /> t__I CHECK 13Ox TO EXPENTE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BU51NESS DAYS
<br /> SIGNATURE OF:APPL.ICAW /� . DATE �(�. Oq
<br /> Department Use OntY
<br /> FILE ADDRESS UNrr 4
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<br /> ENVIRONMENTAL HEALTH DEPARTMENT ALES
<br /> Er UNDERGROUND TANK(USYj CLEANUP SITE(LOP) 0 HOUSING ASAYEMENT 0 SOUR WASTE FACILITY
<br /> (�r'oTHER CLEANUP SITE(NON•.LOP) O FOOD FACILITY A SOLID WASTE VEHICLE
<br /> NUERGROUND TANK(moNITORING1R movAL) d DOG KENNEL C3DAIRY �
<br /> HAZARDOUS WASTE GENERATOR 0 GHICKr;N RANCH ❑ PKG TREATMENT PLANT I
<br /> ❑ TIERED PERM TrED FACILPI'Y ❑ NkOTELIHOTEL, M PUMPER TRUCKIYAaftHEM TOILETS
<br /> ❑ TATTOOISODY PIERCING G POOLISPA .i 1:1 LAND WE APPLICATION SITES `
<br /> 0 MEDICAL WASTE FACILITY ❑ OTUIER(PLEASE SPECIFY)
<br /> 1. - List cap to ten addresses in the space above. Select the type(s)of flies from the list above by checking
<br /> the appropriate box(es). At least Ong file type MAST be selected. Fax to(20 9)464.0133 or mail to the
<br /> Address indicated above.
<br /> 2. EHD will notify the applicant If any EHD Files exist. An appointment for review will be confirmed
<br /> approximately five business days but no later than ten(10)days after recelpt of application. The files
<br /> will be held for a maximum of five business days for review. Appointments should be scheduled
<br /> 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
<br /> of the applicant. Future file reviews by the Same applicant may require a$93.110 deposit prior to review. $
<br /> S. *TENTATIVE appointment dates must be confirmed with EHD staff.
<br /> 6. Applications received after 5:00 pm will be processed)the next business day.
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<br /> u Ht1 Wmll il0fl�the applicant cf an_v ER 13 files exist. An a. t
<br /> ill be held o five business �ay�belt no lafOr than ten (0) days after�recnipt of all be ppllc�orn� She fifes
<br /> will be Izeld for a tt)axirr►trrrl n fi.r basis es days for review, Appc�intlTiori SiloU(t(be schen Jed
<br /> The
<br /> accordingly,
<br /> A file that Is active) being vv
<br /> application Y C�F'Sc C1 C II by EKED staff may not be 8lttrne�l1 tely available for review. A new
<br /> 4. Lays slabmit€ed ! rl the file is availa�rl .
<br /> Any file not returned in tfil mc';,. nditi" as released wY l be reorganized Icy EIdD Staff at the expense
<br /> of thQ applicant, Future the fec�°1eVvs b t,hn
<br /> 5. 'TENTATIVE a y Sarre applicant may requlre a$93.00 !deposit prior to review.
<br /> 6. APPlications received after, lssn��xa�be pror-Onfi coed with
<br /> ithe nexHD taff.busass
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<br /> i C�J�dRRMEl�APP®II1ir(�gFNI DATE � day,
<br /> DATE CONFIRMED -�-a -� TIME..-.._�._..-�._.�`
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<br /> RFVIE1�JEpPAX � I
<br /> YES
<br /> io AA•oz�pB R S REVIEW DATE
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