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\ — OCT -17-2002 14:53 <br />`r UAII: )(UNIVEo <br />V M <br />SHAW E AND I SAN JOSE 408 437 9526 P.02i02 <br />SANi4QUIN COUNTYPUBLtC HEALTHViCE•��oaHues� <br />-. <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKrON CA 95202 OCT 1 7 2002 <br />(209) 46A-3420 <br />PUBLIC RECORDS RELEASE APPLICATION �-nWE! ,n!nr;r-r.rr ,aP:ni Tu <br />APPLICANT J10 GC1ORX e a (16 BUSINF.SSIAGENCY <br />Aotmess__ A*i@i! 157.21 k.,n o [.,►ad Ave <br />k✓ Ghv�'ronr+zr <br />PHONE ea e- 3SQ'SW / % ' FAC.SIMi1.E y�/2� �' g•5^�b n <br />TENTAT1Vt APPOINTMENT DATE � D,2 / o J 1 TIME Y;�!,� /a}►r/% -- <br />• <br />(Pleasii give I to from Itoof application sulMtlltai) <br />CHECK BOX TO EXPEDITE REQUEST • S09.00 FEE -Re ED IN 3 BUSI]MESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />ENVIRONMENTAL. HEALTH DIVISION FILES . <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING A13AYEMENT 0 SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) 13 FOOD FA=" 0 SOLID WASTe VEHiCL$ <br />UNDERGROUND TANK (MONITORINGIREMOVAL) d OOd KENNFL D DAIRY <br />HAZARDOUS WASTE QMRATOR © CHICKEN RANCH 0 PKG TREATMENT PLANT <br />O TIERED PERMITTED FACILITY IV107EUHOTEL 0 PUMPER TRUCKIYARD/CR%M TOILETS <br />SITES ' <br />C1 YATTOOIBODY PEIRGING ❑ POOt1SPA 0 LAND USE APPLICATION <br />0 mEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEMO OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091 4640139 or mail to 00 <br />r address fndic'ated above. • <br />2 EHD will notify the applicant If any EHp (ilea axtst An appointment for review will be confirmed <br />approximately five business days but no tater than ten (1o) days after receipt 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 bieing 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 Irt the same condition as released will be reorganized by END staff at the expense <br />of the applicant. Future file reviews by the sante applicant may require a $89.00 deposit prior to review. <br />S. 'TENTATIVE appointment dates must be cortflrmed with EHD staff. <br />6. Applications received after 3:00 prn will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE. TIME , <br />DATE CONFIRMED _ PHONE FAX INITIALS .._,..�. <br />REVIEWED YES NO REVIEW I:IATE <br />TOTAL P.02 <br />