Laserfiche WebLink
i <br /> .. r° �' <br /> SAN i�Q' IN CQUWE YPUI�LJC 1"f;�L t d tib it.�S i <br /> NVIRON MENTAL HEALTH DIV)SI <br /> 304 EAST WEBER AVENUE;THIRD FLOOR <br /> STOGKTQN-CA 95202 <br /> (209)468-3420 <br /> ,:. <br /> PUBLIC RECORDS Rr=LF—ASE APPLICATION <br /> APPUCANT ' BUSINESSIAGENCY I' <br /> p $ foos` <br /> lr�t iso CIA <br /> apsaos� <br /> PHONE Q -/0 �Acs,nIlL£ 4 r7 —L)/,,9 <br /> TENTATIVE'APAOINEN7 OATE TIME <br /> TII[ <br /> (please give 7 ra 10 bus-kers dsys fron]date Cd appllcatlon submttsl) -, <br /> 7 <br /> :BECK BOX T4 tXPEWTE REQUEST.St"0 F W—REQ £ST PROCESSED IN 3 EUSiNE5S 13AYS <br /> SIGNATURE OF APPLICANTDATE <br /> �. <br /> FILE ADDU=-SS <br /> 1 ' ag r <br /> 4 <br /> i <br /> EMVtRONI F-N-TAL HEALTH DIVISION FILES Q <br /> uNDEftCROUND TANK(U5T)CLFANUP SrTE(LOP) 0 Hot,15ING AaATfwMENT � 0 scuo w,A5-v=FACILUY <br /> �t A <br /> OTHER CLEANUP SITE (NON- 0P) 0 FOOD FACILITY Q IR WASTE VEHICLE � <br /> Ck uNc31=RGROUND TANK(MONITORINGIREMOVAL) 0 DOA KENNEL � Dt] IFrY <br /> HAZARDOUS WASTE-G�IJGRATQR 0 ChICKEN RANCH = PICC TREATMENT FI.ANT <br /> CI TII<R£D PERMfT'M-U FACILITY 0 MOTELAHOTEL Q LANDPUMPR'TfZL1Cl APPLICATION <br /> SI 6 7d1LE'lS <br /> 0 TA7TOOMODY PEIRCING 0 POGUSPA ❑ LAND U51r APPI.ICATL4M 5tT>r5 <br /> M P4EDICAL.WASTE FACILITY 0 PUBLIC WATER SYSnM d OTNEII(PL EASE SPECIFY ABOVE) <br /> 9. List up to ten addresses in the Space above. SeleCt the type(s) of files from the list above by disc ng <br /> the a{aprbgr:ats box(es). At least area file type MIDST be selected. F x t 2 9 Q6d-0- 38 nr mail to the <br /> address indicate .aba►+e. <br /> 2. F-HD will notify the applicant if Any E}HD files exist. An appointment for review will be conflrrned <br /> approximately five business days but no later than ten (10) days after recaipt of applicaticn- The files <br /> urn fiv4 business days for review. Appointments Should ba scheduled <br /> well be held far a rnax�Im of _ _ Y <br /> accordingly.' <br /> A file that is actively being worked an by EHD staff may not be Immediately availaksI- for review. A new <br /> application may be submitted when the rite is available. <br /> 4. Any file not returned in the same condition as released wilt be reorganized by EHO off at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.40 deposit prior to review. <br /> s. 'TENTATIVE appointment dates nniust be confirmed with EhI.D Staff. <br /> G, Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED - _-_-- PHONE FAX INITIALS <br /> REVIEWIED YES NO REVIEW DATE <br /> EN OO 14 OUGMU0 <br /> r <br />