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n , �A` ' l 0 SAN JOJ6UENVIRONMENTAL HEALTH DIVISION <br /> SOVICES 00/064 S/ <br /> WEBER AVENUE,THI <br /> RECEIVED <br /> tl 1 -' E E g�-�� 304 EAST STOCKTON CA 95202RD FLOOR <br /> (209) 468-3420 <br /> MAR 06 2000 PUBLIC RECORDS TI <br /> i LRELEASE APPLICATION <br /> rIL�(�R�}fV �}� 4I BUSINESS/AGENCY. <br /> fPer 4 Sr <br /> PE <br /> ADDRESS f l SZ <br /> PHONE `l"lg 2ZZ L t c Z FACSIMILE_ q'I y `I Z-r—Z . <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 1010 business days from date of application sub ittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS D 06YS / <br /> SIGNATURE OF APPLICANT ::7� DATE ( ? 6U <br /> FILE ADDRESS <br /> C 7a34J l W c-i� L� 5'4�1, .ft C <br /> I� <br /> �� ENVIRONMENTAL HEALTH DIVISION FILES <br /> , NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0- SO ID WASTE FACILITY <br /> of THER CLEANUP SITE(NON-LOP) 13FOOD FACILITY 13 SO ID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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(209) 464-0138 or mail to the <br /> address indicated above <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) 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 being 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 in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. 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 /> REVIEWED YES NO REVIEW DATE <br /> FM IIl1 n nrnernn .. <br />