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U7/11/ZUUU 11:47 FAX 925274110 BBL SAN FRAN Wj002/00�' <br /> ENUIREMAL HEALPAGE 01 <br /> G640�38 ONM <br /> 0?/11%G 006 11:35 EHO LOG NUMT R <br /> SAN J®a,QM Caves <br /> ]EINMOr1MEvTAL RMTH]DEPARTMENT <br /> ` ?i 304 EPs$Weber Avenue, 3rd Floor,Stocktor�CA 952012708 <br /> Telepbo e, (209)468-3420)F= (209)464-013;3 Web:wws�v.sjgov.pt leFld <br /> _ PUBLIC RECORDS PXLE,AASE APPLYE'ATION _ ---a- <br /> p��I � BUSN ES6IAGUNCY: <br /> jAk114 zc SU TIE �_ciTM tx STATE. <br /> PHONE(1): ��7���1�� �- PHONE(a): !� =366 a �FnWMILE:2!S--2i 9 —(Iql <br /> TENTATIVE`APPOIKTUENT DATE: Z.6 .)LAL ?�6 Thr1a: 0�00 <br /> (PIS z0ow 10 baetness d7p from date of Appllc tion submlttl-,7entatltis only-must be cWirmeo, <br /> E3 CMFCic Bt)T(TCI EXpWDITE REt2UESTi -S93 tCASH OR ctiEcK omL7)-FrL-QLFE.ST F ROCFAC EI]IN 3 5WINESS DAI'S <br /> le--\ r — La <br /> SIGNAJURE OF APPUCANT , DATE [! <br /> E)atai�� ❑Map-Desetipoon <br /> htfulitfl9ti�On ,,,..... <br /> ", �•• = t ILM UR 3 EHD USE ONLY <br /> Sta�aat iF Surat Name MY <br /> us O Unit 1y <br /> 2. _ /Unit 2 <br /> 3. <br /> 4. X Unlit .3 <br /> s. --- ; elrinit 4 <br /> Unit 1- <br /> . } VU nit f <br /> spectfia Data Rarvpa of Informz iotl Requested:From <br /> FNVIoRQlhlMENTAL HE-ALTH DEPARTMENT FILE$ <br /> ,� ❑HOMING Atd I—OWNT 60tjDWA$Tr,FA0aMY1V�cZ <br /> UN ( <br /> QERrRUxDTAxK(UST)CLEAN ?*rI a(LOP) <br /> , WASTE <br /> TIM <br /> OTFjERtANUP SiM(NON-LOP) 13 FOOD FAQUPY <br /> UPtbERGROWID TANK(M0NIIORGIREM0VAL) O Doo KjumEL nUF;Y AT <br /> R )MATFMT"T <br /> H, anocs rasrGENERATOR KN RE � <br /> 0 MQTaLIH=L ❑Pt1MPER�ARDIGtE69IGAL MET; <br /> Timm- Pe:SXn-MD FACtt1TY ❑POWSPA V_LAND USE AFPUr–';TICN GMT' <br /> y0 TAi7wrBouy P ruzoNG ❑MER(PWASESPEc1F'f7 <br /> l _ r•-- <br /> 'MED-r.ALYYAZIE FfirRJTV <br /> AONDAYwAY s:oo AM :)0�� Et�G MOI aDRY3. <br /> Saamo P 1---- <br /> WeuAND ROJA �..��a. <br /> list <br /> boYe <br /> I. List up to tOn addresscm in the Space above, select the type( v4 files 09 the 41 8 or or bl to the addmss-3 <br /> appropriate box(es). At leat;t one file type MUST be selected. Fax toL�_ ntae <br /> indicted abata�►e• Address ran3ra will not tae accepted—for additianal assistnce with file addresses) <br /> thT t=HD.Applleations received after 3:00 pm will be processed the neat busing days <br /> 2, The EHD will notify tte applicant if any EHD files exist, An appointment for revlew will be confin'" <br /> approximately ten(10)day;after tec*1� pplicca d accordingly.es will be held for a MEXIMum of five business <br /> dap.,.,for revi�. Appailntme�nts e sc <br /> 3. A fiBe thst is aE <br /> ctirely being worked on by ti47 staff may not be Immediately IM11able for review, A new <br /> application may be submitted when the file Is available, encs of tllrs <br /> 4. Any file bot retutned In the same condition E.s released will be roe o an Q4 drrj�aslt staff at the <br /> rev w - <br /> applicant. Fttture file reviow-q by the same applicant m,%y raqa �--- <br /> Y ,4- <br /> L <br /> �nntrvonu <br />