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e� a-11 �•� IJVIIIJI�I4Ni <br /> �. SAN JOAQUIN COUNTYPUBL,IC HEALTH SERVICES <br /> '.ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE;,THIRD FLOOR <br /> STI OCKTON CA 45202 <br /> (209)4683420 <br /> PWB.LJC tRECORDS RELEASE APPLICATION <br /> APPLI ANT .iiYY1_(1� 9�`I�!" 6USIpNESSIAGENCY r12j' �'pM�`r <br /> 'ADDRIsa &D t Yy,I-a- �- G l tie,. q�•� Nc V •P 1-.•� S oU/-kms_ <br /> •PHONL� s' I.J�,�]I�' o�`�OO I` FACSIMILE I l 'C - -'; �."��-' <br /> TENTATIVR'APPg1NTMZNITI DATE TIME <br /> (P;CC:k V117 w 10 b since*clays from Yale of appiicall on sukrwl <br /> �y/ <br /> L� ChECKeOx7OCXPCDrrEREQUEST•SeT.e rEE-REQUf:STPR0CESSEDIN7BUSINESSDAYS <br /> SIGNiTUREOFAPPLICANT Aye 9� DATE 7 <br /> • i <br /> FILL gDORE3$ THIS sLDE PRo yTAFF USE ONLY <br /> i PRO0RAM ELEMENTS SEARCH <br /> L - t <br /> 3 4 5 <br /> 3S t. a <br /> a �ri ay• n i <br /> r.. <br /> MI <br /> n ` ENVIRONMENTAL HEALTH DIVISION FILES <br /> �UK H(LGROUN4 TANK(UST)CLEANUb 917E(LOP) 0 HOUSING ABATEMENT 0 SOLID WASE FACILYTY <br /> t9r E CLEANUP SITE(NON-LOP) 0 FOD*FACWTY E2 SOLID WASTE VEHICLE <br /> IV VN, EtGROUND TANK(MONITORINO,*EMOVALj ❑ DOG KENNEL O DAIRY <br /> TM H ((ItDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13 PHO TREATMENT PLANT <br /> TIE It PERMRTEO EACILITT ❑ MOTEUN07EL 0 PUMPER TRUCWARDfCH9UTOILETS <br /> (D TA 6GEMODYPEIRCING 0 PgOL/SPA 0 LAND USE APPLICATION SITES <br /> a ME IGALWA.STEIACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER[PLEASE SPECU'YADOVB) <br /> 1. � List Up to tan addrossts in the space above. Select the type(s)of files from the list above by Checking <br /> the appropriate At least ona filo type MUST ba selected. Fax to(2091454.0138 or mail to the <br /> address indicated abovd. ' <br /> 2. ' EHD will notify the eppllbant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five busiriess days but no later than ten (10) days after receipt of application,-The files <br /> will be hold for a maximum of five business days for review, Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff inay not be immediately available for review. Anew <br /> appticalion may be subroitted when the file is available. <br /> 4. - Any file not returned in the some condition as released will be reorganized by EHD Staff at the expense <br /> of the applicant. Future rile revlows by the same applicant may require a 307.00 deposit Pr)or to review. <br /> 5. 'TENTATIVE appeintme6t dates must be confirmed with EHD staff. <br /> S. Applications received after 3;00 pm will be procassed the next business day. <br /> is <br /> CONIFIRMED 41PPOiNTM6NTUATE TIME <br /> I <br /> DATF,iCIONPIRMED _ _ PHONE: PAX INITIALS <br /> REY14WED YES NO REVIEW DATE <br /> N—201A •0 rin TnTN O al{ <br /> C7b7-ICC-CJJ:Xe1 nwAA — rlmHx fel <br />