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19/2004 16:14 FAX 6439049 001 <br /> SAN JOAQUI N COUNTY <br /> _`. ENVIRONMNTAL HEALTH DEPARTMIENT <br /> 304 E Weber Ave 31d Floor Stockton,CA 95205 <br /> 2039)468-3420 Fax: (209)464-0138 Web:www.co.sa.n joaquirl.ca.us/ehd <br /> PXTBLIC RECORDS RELEASE APPLICATION <br /> ' <br /> Do <br /> APPLICANT: (� � BUSINESSIA <br /> GENCY; <br /> ADDRESS: A 'io �✓ <br /> ( <br /> PHONE: C'1{ l Cfb 3 t`L"2(t t —FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: U04 TGne: <br /> (Please aflaw 10 business days frvm data of applic=tlon submtdal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.00 rEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 10 jjqj <br /> Deparimenl Use Only <br /> FILE ADDRESS UNIT <br /> +" G ❑ Unit 1 � <br /> z streetCW0 ThorQ <br /> a. <br /> &—s -%201P �1 Y n ❑ Unit 2 <br /> 4" sneer 3 ( Tkr 11D"-VD-V2 <br /> Unit 3 <br /> a" street <br /> T s,� Unit 4 <br /> 5 Mw <br /> add I` ""1 [] Unit 5 <br /> 1 DEPARTMENT FILES <br /> UNDERGRI ^ ! [©�1�.�" ' 4TEMENT O SOLD WASTE FACILITY <br /> IM OTHER c of ,G rY o soup WASTE v�lcLE <br /> j�UHAZA� Ci DAIRY <br /> G`TiERED PE -1 ` 1 BCH O PUMTREATMENT PLANT <br /> L O E APPPER CLICAHS[TE5��S <br /> 13 T N SE SPECIFY) <br /> O MEDICAL y <br /> 7. Li ct the type(s)of tiles from the list above by checking <br /> th ST be selected. F 209 464-0138 0<mail to the <br /> at <br /> 2. EI . An appointment for review will be confirmed <br /> al; n ten(10)days after receipt of application. The files <br /> wl -_ ___-- -_ for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by END staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not retumed In the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with.EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMO 49424M <br /> 8l8rW73 <br />