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X03-24-05 04:1Opm From- _ T-321 P.02/02 F-T62 <br /> SAN JOAQUIN COUNTY <br /> ENVIItONMENTAu HEALTH DEPARTMENT 13Z <br /> 304 East Weber Arvenue, 3`d Floor,Stockton,Cly 9 "gov-08 � � �A <br /> feA�. 9. A 700Telepboae: (209)468-3420 Fax:(209)464-0138 Web.�v�18 � <br /> ENVIFONNIEV HEALTVU$LIC RECORDS RELEASE APPLICATION <br /> /.✓JP /C.F r 13USINEWIAOMCY:�. a� ��•— ��� <br /> APPLIcANT e f <br /> ADDRESS: `u � E/ D <br /> o AcsIMILE <br /> 44 '7HPHONECA: <br /> PHONE 0): <br /> f-if <br /> TENTATIVE'APPOINTMENT DATE: - p Time: <br /> (Pleaso allow 10 business days from data Of APP Ncadan s�e�-•rontsd a Only-must be wnn <br /> 40 <br /> (7 CHECK9OXTOFq�REREQUE9T-$S3Aa a RCHECK LY)-RMUESTpgoc SED'IN3 ��T�S <br /> DATE Z <br /> SIGNATURE OF APPLICANT, <br /> UNrT D1sT1uuUT10N G Una 1 p Unit 2 ❑UPN 9 M Ualt in unit 6 Q Units t] other(elearoniu0stsllaaPd <br /> FILE ADDRESS EHO USE ONLY <br /> SwMf SWINKHame cit <br /> 1 <br /> e Go i us <br /> 2. <br /> 3. ° <br /> a. r <br /> 5. <br /> 8. <br /> 8. r< a411111110w <br /> 9. <br /> 10. to <br /> Specific Date Range of Infprmation Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I7 SCUP WASTE PAGLRYNEHICLE <br /> O UppF.RgaCUNCTAMC(UST) Urm(LOP) M HCUSINg ASATEaENT MWAVMTRZ <br /> 17 o1HBa cLzmup 511E(NON-40P) (3 Doe FACIUIY 17 DAIRY <br /> MT <br /> G UNOea MMM TANK(MCNnORIN61REMOVAL) Q Doe KENRA p WAS7EWA.TuGKMA TN M TO" <br /> 0 HpTARWWWAMOeNMutoR p M OTTOL� ❑ LAND LNF u PUCA n" <br /> C$Tlemo PERRn16V FAMUTY G poousm d LAND USE�tw1CA <br /> C)TATr*WDMY PIE110IN i n Oni"(PLeAss SPE <br /> Cl MDOICALWAI;w FACI1.tTY <br /> wELI,APID 9EPnD Pbw=RICORDS ARE AVAMDLeFOR R51 " • MONDAY-FRIDAY B:00 AIASroePN - 0(cWDalO IPA <br /> to ten addresses In the space above. S led the type(s)of files from the Est above by checking the <br /> 1, Last up P Fax t0(2091464 013&arm e e d <br /> appropriate box(es). At least one file type MUST be selected. __ ____ _r-- <br /> „al�eted above- Address ranges will not be,accepted-for additional assistance with fits adeye des,contact <br /> ext business day, <br /> the EHy D.Applications received after 3:00 Pm�G ex processed nappointment <br /> a Hent for review will be confirmed <br /> 2- The EHD will notify the applicant if any EHO f11es exist An PP ntm of five business <br /> approximately tan(10)days after recelpt of application. The files will be held for a m2udmum <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively b®Ing worked on by EHD staff may not be Immediately available for review. A new <br /> application may be submitted When the file Is available. at <br /> 4. appl henot returned in the nt Future fila reviews same <br /> rho condition <br /> applicant may require a$93.00 depr9antzed by osit Prior to <br /> j released will be rec review: <br /> ensu of the <br /> o <br /> 7671 �a°✓�' OJ Pf� <br /> POst-it'Fax Note F 1 <br /> c, To <br /> —• CO. <br /> Phona?I <br /> '::' CoADap4 <br /> PWB <br /> hos P 7 yx♦ i ' <br /> BNo1&92aa6 <br /> 11131Ad <br />