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EH OO 14 (REV 5194) SAN JOAQUIN COUNTY n <br /> PUBLIC BEALTII SERVTCF-9 '_I �i evi euJ { <br /> ENTMONMEN'TAL IIF ALTH DIVISION <br /> ii <br /> PUBLIC RECORDS RF7.FSGE Al"PlICATION <br /> APPSICANT_ �lpnllPl ( (vIn�lXStm PHONE NO b 32-0 32-2-`f <br /> ADDRE5S Z <br /> AGF1vCY NAME PRONE N 87_1),32.24 <br /> AnnaEss „u 1 s raTA� .,� .�,, r„sS•lr s , , r .� gym <br /> `{u Sites �n Sit/CaE'Tr7 <br /> FILE AI]DRFSS LF-AD AGENCY DATE <br /> //�/(o E/Tlvic'�ist S�a2e� <br /> ,3SO� <brbnP�do (gGPna�a <br /> i <br /> TRIS NanCE IS SUBJECT TO THE REQU13111-h[EN1S IDPNT3FIED 1N T149 PVULIC HEALTH <br /> SMXVICE.�ENVIRONMENTAL HEALTH DIVISION (EHD)POLICY#94-007, ORDINANCE COLE OF SAN <br /> JOAQUIN i COUNTY. ERD PEES AND SStV]CE CHARGE RMOLUTIONS, STATE WATER CODE. <br /> GOVERNMENT CODE AND THE EVIDENCE CODE <br /> 1. A}MAXIMUM OF TFN (111) rtowim Avoums Gs P" RL:QUEsT- <br /> i <br /> 2_ PURuc FILENPECORD.S REVIEW is BY APpOINTM9NT O. NLP. AmtNT EPM ARE ARRAMeD ar <br /> CAL u ;i (2.09)468-340- OFFICE lams Fore AFPORiTMEHr9 ARE 9cHEnuLL7 MONDAY nuu FruaAT <br /> E.4CLIJI)TG HOLIDAYS, 8:00 AM TO 12.00 NOOK Ano I.OD PM TO 4;JO em, <br /> Zo9)SYrt 31u ; /rlAr�- <br /> 3. A i FusLIc. RaroRns RELSAsr APBLICA-mm (PRI A)C REQUOeRa- <br /> `. LIC PILES/RECORDS NOr Rsru"EO IK TRE 9Ams CONOrr;urt As R9C£iYED WELL RE CORRECTED <br /> RY THE .EllD STAFF AT THE E'ITHNSE OF THE AFPLmANT. THIS ADDITIONAL SERVICE WILL BH RILLED TO THE <br /> APFUCANTIFOR PAYMENT- (SEE EHD POLICY 94-007) <br /> 5- 04IOff4AL PUsUc RLES/RECORDS sNALL NOT HE R dovtD FRom THK EBD Pmwes. <br /> SIGNATURE OF APPSI DATE <br /> I <br /> 510NATUR.EOP,RELEASING OFFICIAL DATE <br /> No PHSJ HD REcORDs/Fu.0 ARE TDEK TR Mt <br /> PHS/EMD RECORDS/FiL.0 EXMT wr TIM ADM M(W) NaM. YOU WILL BB NOTIMM WKEN <br /> RECORDSIFILBs ARE AVAILAELE FDR RSW"- <br /> Lwe Pm.ww m lb,wata Mx <br /> TOTAL P.OI <br /> TOTAL P.01 <br />