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I p' .� I 05 : 14 v PN Bft URDB RSE. . _ 20933914-i 95 P. U I. <br /> JUN-02-03 <br /> uo.uu crop <br /> In:v/ 464913P EM/IRUh€NTFL HEAL•fN I't1C� Ul <br /> 7t R CevSq ..___........ <br /> Inl� :l.s� ,�ll\(l� �ni SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH, DEPARTMENT <br /> MA <br /> 304 E <br /> T WEEER AVENUE,THIRD FLOOR <br /> JUN (1 2 2003 1313 cirvcKrON CA 9s2o2 <br /> (209) 4a"20 <br /> _ilv, ;uNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> (APPLICANT P GAZA Hr1m <br /> Tyr ADDaeas r140 S, R rXm6k' tu. 25nk'. 15 <br /> CPHONE 33 41- 07 q I FA09NILE 331- D I Q <br /> i <br /> TENTATIVE'APPDWTMENT GATE TIME --•--� <br /> (ruses eh'.T to 10 bwlna.e tl�rye irwn dM.f.ppllo.tlon.�6rNW li <br /> CHECK BOX TO EXPEDITE RIM13T•$89.00 FEE-Fmou ':f IaFD IN a 501Naa8,DAY! � LJ`� , c . JJ/ <br /> -*SIGNATURE OF APPLICANT glt� DATE <br /> Fl.[ADDIu!a] Trfa spa f i♦a'I�TN'!U3W��'NLY <br /> PRO9tWN111LI:IMEN"a s Jul O <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UBTI CLEANUP SRR(LOP) ri HOUNNO ABATEMENT ❑ IIOLI:N'MTII RACIL MY <br /> OTHER CLEANUP a171(NOOKOP) O FDOO FACILITY ❑ a0U:oA1A3TI!VEKKAA <br /> ex UNDERGROUND TANK(MOMTOIUNglREMOVAL) O DOG FENNEL ❑ DAIRI' <br /> .4 HAZARDOUS WASTE GIMERATOR O CHIGPINRANCH O M(O TRHATNI',NT PV.NT <br /> i4 TIERED RRMnTW FACILrIY d wn VHOTEL O PU?NIEFI TRIJI;K1Yd1RDMNIiM TOIIET:', <br /> EI TATTOOMObY 111MCING O ".SPA ❑ LANII VI EAt"WO At10N Ent:a <br /> 1#MEDIDALWA3T1F=LITY I: OTHIIR(PL AALSPKCIF11_ ---.--•- - - — -- <br /> 1• List up to ton arkirasast In the specs nbove.. Select the type(e) of fibs frnm the 1 at e)b0vo Gy checking <br /> "appropriats box(es). At hast ons ilia tyes MUST be asleded. &{tLtQl3S'pL?tl!!�1itll nL12y1]l�Liht <br /> address Indig lid sbovr. <br /> 2. KHD will notity the appltrerA M any EHD file F exist An appointment for rnvl,l w III ll it0l'a?'Rf!'.rmed <br /> approximately I"business days but no IDhr than ton(10) days after retnllA Of !ppilralt)"i. The Nes <br /> will be held for a maximum of Me buslnsen,days for review. AppDHrftsll.ta shin 1ld ho tuftAuled <br /> ac ordinoly. <br /> 3. A filo that la*W:iwly being worked on by EAD cuff may not be Immedlatriy sval;eblm f1Ar review. A riew <br /> application malt he submlttsd when tho"k,Is available. <br /> 4. Any file not reblmed In the same condition ae released will be rsor(Ianlz+ld Irl El OD OWN At the sl;penan . <br /> of the applicant. Futuro file reviews by the sem*appllsant may require r,$119.0(1 doposlt prior to Wisw. <br /> S. 'TENTATIVE appointment Gates must be cllnfirmod With EHD staff. <br /> a. Applications mcelvod after 3:00 prn will bo processed the next business de vY. <br /> p"4r Fax Note 7E71 Iain ro- I-O +xaee� <br /> CONFIRMED APPOINTMENT DATE — <br /> DATE CONFIRMED �A ca'�' <br /> NO Fez <br /> REVIEWED YES <br /> r <br /> I <br /> vanes <br />