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05/01/2003 07:43 7146711008 E55 PAGE 32 <br /> 04530/$003 1Q;14, -... 564813 trvvinU-11-iu" ` s'..1w�v"Sk: <br /> i�i '�C�f SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAY 0 1 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> $TOCKTON CA 95202 <br /> (209)4G&3420 <br /> EF!\�Iftul'uf•'IF:i')1 HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> j�APPLICANT_ -(4"'I /T <br /> �� eus(NesarArfr(erc n�tv� �°� - <br /> y / ADORE$$ cal a-700 CcclI C� L 'I/� f/r >!`l d71) c ✓ .'�= _�.... <br /> T 1 PHONE ! I (1 -7 ',� / �Gv-� FACamLE 7 <br /> TENTATIVE'APPOINTMENT DATE— TIME <br /> _,-,—_ <br /> ..._. _ <br /> (Please give 7 to 70 twelmeee drrye frau data o}spoi6Nlon eu�.mrieed) <br /> CHECK BOX TO EXPEDITE REQUEST•5e9.bO FEE-itE EST PR(1cESSEO M]WSINESS D,IrY!k E 1/ ` f + y <br /> -*SIGNATURE OF APPLICANT _ � �— DATE^-•S--.xf-V°�------ <br /> �.,.�,.s... <br /> �A3 rCCIn:'IWr- Ar7USE'ONLY �I <br /> FILE ADDRESS —• PI104;R1'J1 ELEVENT'F:MARCH <br /> p N. n(u <br /> r D ' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ''VIUNOERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOuSING ABATEMRNT 0 SCILKI WAI'TV FACILITY <br /> CIEMDPERMITTIEDFACILITY <br /> THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 IOL91 WAtiTC VEHICLE <br /> NOIROROt1N0 TANK(NONROMNC/REMOVAL) O DOG KENNEL al DAmIr <br /> AMDOUS WASTE OENERATOR 0 CHICKCN RANCH 0 PMiG Y14iA RUCKrNMAT PLANT <br /> n MORLIHOTIL O FIIM/'KR T[ItJCKrcARwCHInI TOILETS <br /> O TATTO0100DYPEIRCING 0 POOL/F•PA 0 UNC USE.AMLICATION SITES <br /> • MEDICAL WAWM FACILITY n OTHER(PLIK"E SPECIFY) .—.----- <br /> 1. Lest up to ten addresses in the space above. $elect the type(s) 91 flies from the lintzlbove by checking <br /> the appropriate box(*%). At least one flim type MUST be Selected. <br /> oddr*04 Indigatod ab4Ve.. <br /> 2. EHD will notify the applicant If any END flies exist. An appointment for rovlevi will bn confirmed <br /> approximately Nve business days but no lah rthan ten (10) days after <br /> r Apt lif eppould tle Schad~will be held for a maximum of five business days for review. Appn <br /> accordingly. <br /> 3. A file thot is actively being worked on by EMD staff may not be immedlntely aYaileblo fw mivw. A narvY <br /> application may be submitbbd when the file i.s available. <br /> 4. Any file not returned In the Same condition as released will be reorgsnixed by EHu staff at the acpenso <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposil prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications reCaived after 3:00 pm will ba processed the next buninesa day. <br /> CONFIRMED APPOINTMENT DATE TIME ------- <br /> 1 <br /> GATE CONFIAMPO PHONE FAX INTI IAL;S I <br /> REVIEWED YES NO ^ REVIEW DATE,,.._--- <br /> .ass <br /> Yxsrao� <br />