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3 Darlene J. Gibbons 209-870-1 p.2 <br /> 04/03/2008 16:54 5194988888 KPA FREMONT FAG[ 32/02 <br /> V/ Ii-CEIVED GNU <br /> j SAV JOAQUIN COUNTY <br /> ENvjRON#M,aAL HEALTj3 DEPARTNwNT <br /> !008600 East Ma4i Street,Stockton,CA 95202-3029 <br /> Telepbose:(2.09) 468-3420 Fax:(209)464-D138 Web:ww v,sjgov_otg/chd <br /> HEA N PUBLIC RECORDS RELEASE APPLICATION 5 <br /> AfT'uCANT 1 L 9UMMF AC3t7tCY: <br /> VICES U / (r.� <br /> PHONE(1): O- U I PHIOHE 12): C - U facstlLnl�.oZG_ -�s�l,—�y 7 <br /> TEMTATiVE`APPOINTMENT DAm /TYnoy�tkw; <br /> IPt""*hoer 10 buaihess ys from oata of plluti x�lmtltml.'7sntatfvs only.mid be contltrhad) ' <br /> CHteCK SOX tt7 EXPEDITE REO .S OO F GAS E ONL i-REgUEST pRpCSygEtl IN 1 BUST ESS DAYS <br /> SIGNATURE OF APPUCANT DATE <br /> Elactroniclnforrnation: ❑List[3 Map—Dlascription: <br /> _ FiLt ADDRESS EHD USE ONLY <br /> S"Wt tr Streol Hama CNY ❑ Unit 1 <br /> 2. )nn z <br /> 3. r� <br /> 4. 00,11,Uhll$ <br /> 5 �[ <br /> Unit 4 "\ <br /> 6. 40 <br /> 7. <br /> El Unit s <br /> B. <br /> g' <br /> Units <br /> t0. <br /> SpecMe Date Range of infortnation 11.6e•stod:From 7 to <br /> E MONMMAL HEALTH DEPARTMENT FILES <br /> O U%=MGROl7N0 TANK ffln CLspNuP SnT F) 13 HouwNa ORAATEmoa 1�� Its WA9TE FACItmlYbwcLJ <br /> ❑07ri"CLEAMNP rATa-(T QWLV1P) 17 FOODFACLRY Z1 WA$TE TIRE <br /> O UKOERBROLtNprANK MOMMIUMMIZFMOVAI-) 17 000 KYMNEL n t7Alrty <br /> ,0_6f�,� <br /> LAta]pi1$w0.9'fE(�EHERAMA I7 CrtMfR RANCH Cl WA3TEWATr+TaEATHf NT PLnxt <br /> -9r,hot A PGAU... FACILITY ! C3 MOTFSIHoM �O��,PWy�IPER MCKMARDfCM TOa.M <br /> Q TA17001BmYPtERQMG 0 POMISPA _' ' useAPPLICA S <br /> ❑farcmcALW"vFFAciuTy 1 p6lcca(PL�asssPecl�O 1�,t 1 i_1� aI)e C� —p <br /> WELL,ANO SUP=PFRlllrRECODas AAE AVAILABLE POR R£VE1N-MONDAY�nY AIM A 1$,Mm -ExMUDIM HOLMAvs. <br /> 1. Ust up to tan addresses In the spare above, Select the type(s)of Rias frog•the Uat above by ebecking fbe approprlabr <br /> box(ea)L At least one fife type NIUq'f be selected, Fm to t20 IAM-0138 offla(1 N the address Indicatad above Addir"s <br /> rs npd will not be accepted—for and{ilonal asslutance whh file addrnse49,Oorltact the EttD.AppllcaSG"recelvecl alter <br /> :M0 pm will be processed the rteAI business day. <br /> 2 The EHO will rat>Yj/the appticznt airy EHL]files Deist An eppotl►4mentfor review wilt he coaflrmed approximately ten(10) <br /> days sfterrewipt IN appllcatfon_ a files win be held for a maximum of rim bus rwAs days for revitm. Appolntrrrerds <br /> should be scheduled accordingly. <br /> 3. A file Ihat is aetMeiy being tvorloed an by EHD stall mtq not ba imn Iedlataty evallable for revle++. A now application may he <br /> sub milled when me Me Is avallsblI. <br /> Al- Any fie Trot retur,fad in the carne cbrtdldon as releasad win be reorganized by EHb staff at the ezpehma of the appTieant <br /> FLmur Me revlem by the same apORcant may require a*91.00 deposit prior to ruvfo-, <br /> EHD USE ONLY <br /> eo+saa eason-r i <br />