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Piti n:.•LIvLN k��� I u�jf__ <br /> y SAFE .ICAQUIN CC)IJMT'�RUgUC H>=At-YH SE �liI�.ES � -1 - l .� L�,I(_�, <br /> ENVIRONMENTAL HEALTH DIVISION J N 1 1 2001 <br /> Sad EAST WEEDER AVENUE,THIRD FLOOR <br /> srocl�TQN CA 95?02 :3(s ENVlR�. fdMEI��aT ric�\LTH <br /> (2n%) 454-3420 <br /> PUBLIC RECORDS RELEASE APPLICAT10N PE MIT/SERV CES <br /> mP•1�- - FT6Y�—%4..i <br /> � 1 <br /> APPLICANT_�_,•� �CX t�I �G�tai L� BUSINESS)AGENGY_ �'F s tt <br /> ADDRESS._� �_�J tiIfkc1. ?1�IE?VILLL � � A Iia k'&°.Lkti CA <br /> TENTATIVE"APPOINTMEN'rDATF1 TIME <br /> (Rlaa5t oivu 7 to 10 pusinc s days from date of application submittal) <br /> L4" LUU11 <br /> 71 CHECK BOX TO EXPED(TE REQUEST-478 to F-E-REgUC;5T PROC 9SED IN Z BU51iNE55 RAYS <br /> 51ONATURF OF APPLICANT `-- DAT: l e Q f <br /> FILE ADDRESS THIS%)P? EHL]STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1. ��-$ ttkt•�°.+'IQo a r: t'v L.,U� ! • <br /> \+ 1 3R Irmo C ayroQ _l,ti.5-r <br /> 4 uric k tea+ Z-tP <br /> ENVIRONMENTAL. HEALTH DIVISION FILIES �Ah�' 16 / r1 <br /> (PULNDERGROUND TANK(USTI CLEANUP SITE(LOP) ❑ HOU$INGABATEMENT Q SOI-ID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) a FoaD FACILITY o SOLID WASTE VEHICLE <br /> UNPERGROUNCtTANK IMONITORINGIREMOVALI o DOC KENNEL D DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR Q ChICKFN RANCH 2 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTFLJHOTEL ❑ PUMPER YRUCKNARD1¢HEM TOILFTS <br /> ❑ TATTOCIaODY PHIRCING Q POOWSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE}FACILITY Q PUSI-IC WATER SYSTEM ❑ OTHER(ftEASE SPECIFY ABOVEI <br /> 1. List Up ;o ten addrasses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box{es). At feast one file type MUST be selected, Fax to(249) dH0138 or mall to the <br /> address indicated above. <br /> 2. END will notify the applicant if any> HD files exist. An appointment for eaview will be confirmed <br /> approximately five business days but no later than ten(10) day$ after receipt of application. The files <br /> will be held for a maximum of five business days for review, Appointments shotald be scheduled <br /> acr,Ordingly. <br /> 3. A file that is actively being worked an by EHD staff n'tay not be immediately available for review. A new <br /> application may be submitted when the file is available, <br /> 4• Any fila not returned in the same condition as released will be re"anized by FHD staff at the expeneD <br /> of the applicant, Future file reviews by tha same applicant may require a $78.00 deposit pricer to review. <br /> 5 `TENTATIVE appointment dates must be confirmed with EHp stuff, <br /> i3. Applicatlon5 received after 3:00 pm will be processed the next business day. 46 8 <br /> CONFIRMED APPOINTMENT 6ATF TIME <br /> DATE CONFIRMFI7 PHONE FAX INITIALS <br /> G�' <br />