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013/21!2005 16.47 925944211 TSG • PAGE P.2 <br /> DATE P.VF,E ^,{^ ��® • D o N 8"J:l^ <br /> �A�JonQunv Com EMLb <br /> +1'e`t Weber <br /> AvoltTAL HEALTH Dort.CA �V20-4 2 <br /> �� 2 2p06 304 East We6ftr Avettue,3`4 Floor, Stockton,CA 45201.-2708 <br /> k eatPltnue:(209)468-3420 Fax:(209)464-0138Veb:www.eigov.org/ehd <br /> Nd�fi(JP1lENT HEALTH <br /> F -BL RECORDS RELEASE APPLICATION <br /> r•i`.1: a [Sa f;6, aK -„�4'/�07i�..,��. ,_,®�s_���BU.sIRIES$fIIGENC'f:���s^e+rr ,•, nP � ',a:. <br /> qy DfPEsa san5r3� c �;nr�.0 Vic€ - <br /> �,f -I- —PHONE(2): _FraCSIMIi.E: 3�i.4 Nk, »2�';�T <br /> 'W TEN'7,A:IIV'E�APPoPNrlw wv: P6net_- _ <br /> il'leasn from allow 10 huulnsas days m date of application submittal.,F(owrva only•must be coufimaru <br /> t '.'tv r-t E P1 MR R€QW,137-196.00 FEE(CASH OR CHECK - e ? -3 r Ola <br /> + — - -- <br /> Eiparonic In6wynation: [I wRt U1 Reap-•Description;_ <br /> uoms.[unn:IRFi 99 tlPNlIAibM�a <br /> TvsR41N2i}ATCbIfHIGtl® vinvammm¢um RYyYia�v:®acb'+.Ta.-mswgc�+^ <br /> FiE.EApAREt ame city EHI)USE ONLY <br /> °haAtA ...-L1.ys,�r_✓.15tri�S6p, k _ — <br /> I �.- --- � <br /> UST <br /> 354- N FF --__--_ <br /> 445b 3.-_�18P'�A• �t1"L+yr�es•� , <br /> J R , <br /> - -C fir►, <br /> 3 1 b;; e�,�1-f e__ �v�•P.f,��•„r4 f' 1e•Y 7 H w <br /> 4490 <br /> } ? aY ! �rkf?±N Bks r v L Units, <br /> �ya� ° `iS�3. <br /> 4poy LrI1' —I (lfieo� AM ¢a{ h}n�_ USY l unf f <br /> 1°➢ t1 rNfi• �f 1.. r"( ,,,,:. ``ll1N``^.r \r a 1 <br /> 'f1ar:R"rr�ate i�aar�e of 9aCvrrnatlara P.ogrs2yiad:From __� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> DNpsacsouNo'rAv;c(r,➢?T) LEANvr 6!re(r.f.P➢ F7 HMM-AaATMENT r soup WAam PAgwTYMiP.rLE <br /> yvlup srm pllooA.OP) 0 FOOD FAP EM WAg1E TIRE <br /> �PJaCL'Rca9.hE fr+%fi(FADxnMNORWOVAl) 11 Doo KENNEL XoArh' <br /> Ha.Rr,c Wga3 -CEN17AI'M dPq3"1oKW RAYCR ;a WAS.9EWATER TFtEA'rW'tt PLA'." <br /> ', Crr.R'mC R:a"(i 1F4ci4'T*' VMOTE/HoTaL 7-PUMPERTTRUON'fARofC"NE.'03SYLM <br /> ,.T'o..e"d„CIra.7:SaN$ C.`POOL➢SPA .td-Wa]USE APPLrATt Srnt "s •-•�• <br /> anKO"C ,WASTE FA rn` 0 O mER(PrEAse SpEa ir) <br /> WEu AND SEPnC PERaR F&M100 AREA MAELE POR REVIEW- atoNopr•FFIDAY M/W-6: bps - EXor r wa HOLwAY& <br /> t Met er to ten addre Aro,in tha spars above. Selaet the type(s)of files from the list above by chocicing tale appropriate <br /> hdx(ea) At feRst one file typedr3US7 be selected. Fax to 9091464.Ot48 or mail V§jLaddmss inclica AddrRis <br /> rangrz will Pct he afcc:pted far addie(nal asskItance with file addresses,contact the EHD.A.pplitatlon,�received Per <br /> »7e, xEJ prarss:•.osF4fr.nand 5zE6nfss day. Lk <br /> FY#'3velli no My the appilcar,t 4 any EHD files exist. An appolnfinant for review will tie confiNned appr;)xI rat'ely tan(191 <br /> 4aye after'recaipt ofappllcation. The tiles will bra held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> '. A file that W actively bring worked on by EHD staff may not be Immediately available for revie!v. A new application maybe <br /> s'uh7,l', whan the iMn ix avaliable, <br /> f n; err:net returned in the same vOndltion as rem-sed will be reorganized by Wrt staff at the exfvrsc of the npilc t <br /> "gat:{, •1116 my ew-A by tdie aar=.e applicant may re,:tuire a$95.00 deposit prior to review. <br /> EHD USE ONLY <br />