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N _ 001 <br /> 07/02/200210:28 FAXFILE <br /> flATe ASAN JOAQUIN COUNTYPUBLiC HEALTH SERVICES � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �► D <br /> 304 EAST vVEBLR AVENUE.'�HIRD FLOOR <br /> 5T 202 <br /> (209 468.CA <br /> 20 <br /> 11&-" PUBLIC RECORDS RELEASEAPPLICATION <br /> �FI.TA G+��r/2a►�/Dfi�,lr}111 l�b,iSSVL7►9—Ps <br /> APPLICANT l4 SEARI) BuSiNF-SS1AGENCY ' <br /> ADDRESS 3164 G!M �lti�r Svr7� W+" .rl.410 '�• <br /> PHONE _ FACSIMILE ?'•r <br /> Y �� - TIME <br /> TENTATIVE"APPOINTMENT FATE _ <br /> (Please we 7 10 usI ess d da pPlicat' subrnittal) <br /> CE=SSED I>�13U ESS DAYS ( .. <br /> CHECK BOX TO EXPEDITE REQU T-S69.00 -REQ 5 <br /> DATE <br /> SIGNATURE OF AP -.6 <br /> • ;r <br /> IM.ONLY <br /> FILE ADDRESS TPROGRAM ELEMENT--------------------- <br /> '1 CH <br /> PROGRAM <br /> L 1Jes-r 6 r cb!.w s+►� !1l93 <br /> G4 <br /> S7af� 1 d <br /> �.ab 5+"I1sm CA 5`T►aTla J1t4o <br /> 43-4z as I'll{�4 CSI iod !1l44 <br /> ENVIRONMENTAL-HEALTH DIVISION FILES <br /> C3 13 <br /> ABATEMENT 13 SOLID WASTE FAKlLM <br /> �UNDERGROIIND TANK(UST)CLEAN<tP SITE(L OP) 13 FOOD FACILITY CI SOLID WASTE VILE <br /> VAER CLEANUP SrrE(NON-LOP) ❑ DOS}KSNHEL 13 DAIRY ATMENT�. AN7 <br /> ERGROUNO TANK(MONITORlNG1REMOVAL) E3CH��N RANCH ❑ PKG TR1rM TOILETS <br /> ❑ AZAROOUs WASTE GENERATOR p MOTEL/HOTEL O PUMPER TRVCKIk%RDN <br /> cv TIEReo PERMIT F-n FACILITY O POOLISPA O LANG USE APPLI��i`�ih IF ABO <br /> 0 TATrOOIBODY PEIRCING ❑ PUBLIC wArER SYSTEM C7 OTHER(P68/45C Sj CIFY ABOVE) <br /> a MEDICAL WASIT FACILITY <br /> List up to ten addresses In the space above. Select the type(&}of f(IQs from the list tfOvb by checking <br /> the appropriate boxes}. At least one file type MUST be selected. Pax <br /> or mail to the <br /> a ss Indicated above. EHD files exist /A►I appointment for review will <br /> �;�onf(rmed <br /> 2, EHD will notify the applicant if any 10 days after recelpt of 20046tlon. The files <br /> approximately five business days but no later than terl ( } y aln#rrients should h*dchadulod' <br /> will be held for a maximum of five business days for review. App s <br /> aceardingly. A new <br /> 3, a Fla that is acts,aly being Worked on by EHD staff may not be immediately avaiialsl`erffor review. <br /> appllCatlon may be submitted when the file a available. <br /> 4- Any file not returned in the same COnd"00 a5 released Will be reorganised g. 0 deiO teff at iOr tO review- <br /> of the applicant. Future fife raviewS by the Sam®applicant may require a S►89A0 dapoeit p ' � <br /> 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B, <br /> Applications received after 3:00 pm will be processed the next business day. <br /> FDAT <br /> NFIRMED APPOINTMENT DATE. <br /> TIME '• . <br /> PHONE FAX INITIALS9�- <br /> E ECONFIRMED ` <br /> L.REVIEWED YES NO REVIEW DATE <br /> In nFnnr <br />