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SAN JOAQUIN COUNT`fPUBLIC HEALTH SDR C <br /> APR - Z001 ENVIRONMENTAL HEALTH DIVisioN ES <br /> 304`EAST WZS!E:R AVEN. UE.TKIRO FLOOR ��t <br /> STOCKTON CA SS20.y.2A9 d8$-3420 , " <br /> PBUC RECORDS RELEASE APPLICATION <br /> APPI-ICAir `Q 1tC!t i L l t1 P BU$1N1r$5/AG13dCY_ r-]_ .� L� <br /> iI <br /> x3 f p(T--ATNE"a1-Pai.%'T ENT ATE_L1)ZA a J , i ,;m1 � rr" ,. <br /> ' ..r,_,. {i.4w-we ggive 7 to 7b busilt-ss days FrorA dam 4f alppGcrtion suixmiti�t} <br /> c7KOOXC Q ExPEDITE REQUEST-557;00 FEar,PIEQ.UEST FROCES;FDfav 3 suslaess DAYS <br /> SIGNATIJfZE OFAPPLICANT _�s��-I � - �.R DATE <br /> i i• ' <br /> V1LI�ADDRESIS THIS SIDE M,sYAFF USE GNHY <br /> PROGRAM ELEMENTS SEAR Ch <br /> AA Ar-h. s � k <br /> 1^ fileRd :-!, a <br /> i 0A <br /> ENV1ROMMENTAI.-HEALTH DI'AS1014 F'LES <br /> i� <br /> UNDERGROUND TA14KtU5T3 CL&,RUF SITE'(LQP) 0 HOUSING A13ATFM:-t T 1;7 SC1fSD WASTF-FACILi7Y <br /> OTHER Cl>rAl��?SCFE:r�vM-COPi ❑ FOOD FACILITY Q ,SOL16 WA44E VEHICLE <br /> >� poG tcFNtiE(. M VA412Y <br /> t LaNDERGRaUND T (MlrrGrJTiG.rFiEt► AL) ❑:11MG Mg,^Th1ENT PLANT <br /> CI�aC, t�Ht1CH <br /> )10 tAZAHDC7[JS WASTE='GENF_2RA"FQ'ft G Md3IWIJHiio?moi. " D PLINaP1rFL rtF2liCK11CAlZD1CtiE4it TQiiETs <br /> Y` G TIERED pFPjA17r5_D FACILITY i G PcOUSPA - ' X LAi1D USE APPUCAVON SIVE <br /> 0 TATrOVSODY FZ3RCIAG >w7 PIJ�L{C3tlfJki ii SYSTEM 0 OTHER(PLEASE SMIFY ABOVF-) <br /> MEDICk1_WAVE FACIIrY III <br /> 1, [.tat up to ten addresses in the space alcove. Select t11e types) of files from the list above by checking <br /> the appropriate bOx[6). At boast one file type MUST be selected, fax to(20 4 -g'138 nr�t to the <br /> address indicated above, <br /> 2_ EHEC will notify the zopilr„ar)t if any tllD files cx1st. An appoi?tinent for review will be confirmed <br /> five busiries�clays but no 12ter that,ten(10) dayr,aftOr fecc;Pt of application. 'the files <br /> will ba heltt for a niaxlmum of five business[Says for feview. Appointments should be aCrisduled <br /> ac cord i gly. <br /> 3. A file that is actively being wa rked on by 1=HD staff may not b4 Immediately available For rewieW_ A reeve . <br /> appiication may Ire sE bmitted when the fil-a is available. it <br /> 4. Any fift reat retisrnedlin the Same enndition a4 released will be r, org:aniaed by EHD staff~at the expense <br /> of the applicant_ Future file reYlawS by the saimg aPPGCant it1�r,egeiine a$87-100 deposit prior to review. <br /> 5. "i ENTAi lv appointment dates must be corfwmed with EHDisaff <br /> t <br /> C. Applications recOlVoO after 3:00 prp will be processed the next business da_y- <br /> �i <br /> r"-CONFIRMED APPOINTMF-14T DATE. TIMC <br /> i' <br /> DAT E CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES ;NO REVIEW DATE <br /> ft'14 "MV0s "TOTAL P.01 <br /> iy <br />