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SAN Jf- WIN CCUNTYPUBLIC HEALTH Sr-7VICES <br /> 1VIRONMEJtlTAI" Ht <br /> AI"TH DlVISIG� l�us <br /> .304 EAST WEBER AVENUE,THIRD FLOOR <br /> V�• STOCKFON CA 95202 � f <br /> (249)468.3420 <br /> (19 i{ <br /> PUBLIC l�C4RDS RELEASE APPLICATIPil-_'•h_,,�,--,I,I ,r <br /> APPLICANT 1) AK_�. } S .�r� 6U81N�$SIACjfE3N�GY -} C <br /> ADDRESS 2.3 !� 1 .� �y�/�� ��ter✓ �� S�[ �} �f��o)E��/w) <br /> PHONIC /^7 �LlQ(i(J ^_� —FACSIMILE <br /> TENTATIVE"APPaiNTMVNITDATE R Q� TIME ---_,.--- <br /> (Ple"e give 7 to 10 burin s days from dale of applicatlon 6uhmit(89 <br /> 1.AP;1� <br /> CHECK 00X TO EXPRUITC R>_QUES 78.00 FEE-REQUEST IOC SSE 9N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> ItIfu <br /> r{ aJ53 <br /> EMM CA <br /> �r <br /> ft ♦r { 1r <br /> T r <br /> . <br /> 71EE 1--� <br /> i h <br /> ENVIRONMENTAL HEALTH nIVISION FILES <br /> U?40E RGROUND TANr%{UST)CLEANUP SITE(LOP) M RGUFING ABATEMENT ❑ SOLID WASTE FACILITY <br /> CJ FOOD FACILITY ❑ SOLJD VUO$"1'] VEHICLE 'r <br /> OTHER C1,.>EANUP 517£(N4N-LOP} <br /> I . M <br /> N08RGROUND TANK(MON1TORINGIREMOVAI_) •❑. DOG KENNEL ❑ [)AIRY <br /> HAZARDOUS WASTE GENERATOR <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT B <br /> ❑ TIV-RM PEiMITT613 FACILITY ❑ ML7Ti`UHPT>EL © PUMPER rE2UClClYAROIm SITl TOILETS <br /> 0 TATTOOlBODY PEIRCING CI POOLISPA ❑ LAND USE APPLIl:+�1TLO51TES <br /> 0 MEOLCALINASTE FAC1LtrY CJ PUBLIC WATER SYSTEM Gl OTHER(PLEASE SPECIFY ABOVE) <br /> I, ust up to tart addresses in the space above: Select the type(s) of files from the list above by Chocking <br /> the appropriate box(as). At least one file type MUST be selected_ Fax"to [2U91464-0138 or mail to the <br /> re indicated above. <br /> 2. 1=HD will notify the appil"rit if any EHD files exist. An"appointment.for review will be confirmed <br /> approximately five business days but no Iater than ten(10)days after receipt of application. The files <br /> will bei held for a maximum of five business daysfor 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 far review. A net+1 <br /> application tray be submitted When the file is available. <br /> h_ Any file not retnrnod in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Futuna file reviews by the same;applicant may require a $7a_oo deposit prior le review. <br /> 5. ''TENTATIVE appointment slates must be Confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be proc"sad the next business day. <br /> CONFIRMED APPOINTMENT VAT TIME <br /> PATI~CONFIRMED PHOFIIE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE � <br /> EN 06 1A W"ioo + <br /> I` <br /> rk <br />