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07/15/2008 10:06 133 107901 PAGE 01 <br /> 10/2D/2086 14:48 4E40138 SAN JOAQL ENVIRONMENTAL HEALTH PAGE= 01 <br /> TIN COUNTY <br /> ENVWOMIENTAL MALTH DEMRTMENT <br /> 304 East Weber Avenue,3'�Floor,Stocktw3,CA 95202-2708 <br /> I Oro <br /> ZUB <br /> Telephone:(209)468-5420 Fnx: (209)464-0138 Web;www.sjgo-v.or <br /> Y.Or C <br /> Lq;��'7L-" 3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SUSINO;WAGENCY: -CM,<a&H71� <br /> ADDIRM:---2,q6-0—C-4wiyip'D(aWo , IL'olwut <br /> PHONE m.- �Lh— Cog I� PHONE(2): <br /> TENTATM"APPOIMUEWT DAM; V1, � Time; <br /> (please allow 111 bmi nan A days from date of application tion submiuni Terfl2live only-must,be confirmed) <br /> CHECK BOX TO rxPizorre 17L MAYS <br /> =$ $20'FEE(7H M,CHICK CNL.Y) IW;QUEST PPOCC$SED IN 3 SOSI""g t A <br /> SIGNATURE OF APPLICANT DATE .7115 log <br /> FJoctronir-Information; List E]Map-Da=ipfion: <br /> i546 USE ONry <br /> Street# FILE ADDRESS <br /> sftot 1411*kilb city ❑ unit I <br /> - <br /> -.3 40 1 rk N(Ac NO <br /> rCU <br /> I Do <br /> rilt 3 <br /> 4. /0-6vS <br /> 7 nit 4 <br /> 7. 0 units <br /> S. <br /> 9. Will 0 <br /> 10. <br /> Specific Dffia Range of Information Requested.From to <br /> ENVIRONMENTAL HMTH DEPARTMENT FILES <br /> - I <br /> N0ER*901 tW TANK(USI)CLCMW SrM(LOP) ❑HOUSM AMAIEWNT OWD WAVM FAcamN <br /> OTHER CLMMO SM(N`GH-LOP) In FOOD FACUTY W 111111M <br /> MURGROUtffi TAtW(MotaorwWRnWA1-V( C DCM KENNEL IDAIRy <br /> qCS WASW GF.MPPATUR�, AsTitWA7M TREATWHT PIAW <br /> ra <br /> 0RY <br /> PERMnTIRD FAOIM6�' C3 MoTWHOM PUMPAPIRDW)YAWICHMA TOKM <br /> TW—1 PT POOLISPAL 172 LAIJO Utt APPUCATION S <br /> Wj C 0AI".8W f!'14cmrr�-x C,OTPr.A(PLEA"-qpre" FXCLumo HOLIDAY& <br /> Wai-AND$Eno PERMIT Fmcmrpt A"AVAIL"LE FOR 110" - MOMAY-FFM <br /> 1. List up to ton addresses In the space above. Salt ft type(s)of filoz from tba list above by chadang the apprOpftto <br /> box(es). At least"a fire typo MUST be selectod. F 1 4 12S all to t add_resM2TjQMtW abova, Addmss <br /> rangesvAll not be ACcopted-ler additional assistance vVitli Me addresses,confact the EHD.Applic2tIons tecol"M after <br /> 2,-00 pm will be proomed the next burin�st day. <br /> Z The rmKn VAtl nofirythe appllcnnt If any 1191)Van exi5t An appointmant for review will bo confirmed gpprox1nMely ton(10) <br /> days after racelpt of applicatlo". The ffts will be hold for a mulmum of fi%ni burinoss dftYc fax r#vlgw..APPOIntmOnts <br /> should be scheduled accordingly. SW immediately avallotbio for revlow. A new applleation may bo <br /> 3, A file that is actively being worked on by EHI)staff may"01 <br /> submitted when the file Is avallAbit. <br /> 4. Any file not returned In the same conditionas reIQ ated will be morgmized by EKE)staff at th®RTome of the applicant <br /> Future file reviews by the sarr&applicant MY mqLflm a$95.00 deposit priol'to rWAQW-% <br /> EHt7 USE ONLY <br /> EKO fn <br />