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_ _ ___ _ �_ ..•V VA -n."Nww•n-titre". .wlN.lrl • rmt= as <br /> 4 <br /> �R1I V UNY� �' cnu LOO NUMBER <br /> '.0"1ZNTAL HEALTH DFpAYtTII� <br /> 304 st�cbcr AYenue, 3*Floor,Stockton CA <br /> Felephoae:(209)468-3420 Fax: 209 ww.3jg v.0t <br /> �} ( )464,0138 Web:vrww.sjgov.orglehd <br /> PUBLIC RECORDS <br /> APaucANr: RELEASE APPLICATION Z3 <br /> AWft": LoNe Q V NUSINBBSIAGENCY:_4X A Sc1_,=erFc <br /> P'ifoNE c�). •5'1 a 'L2, CITY_Acp_ STATE___C-4 <br /> TENTq�NT DATV: .p ACS : 1.°�•5 'Z - <br /> tE Moires$$don�tR dale W aPPlip►tton•uballgl.•renjeevo on y mmtrtt by conAryn ed) <br /> C3 C ECK BOX TO uxpeM Q T-SUN FEE CIlgF10R <br /> SIGNATURE OF APPLICANT ( C 4ECK(*Ly).REQUEST pROOM"IN S susM$DAYS <br /> DATE <br /> aawe# F <br /> t• END USE ONLY <br /> 3. 0 Unit 1 <br /> 4. <br /> O Unit 2 <br /> 6. <br /> it,3 \�1 <br /> s. <br /> Spedfk mate Ranpe of hlformation R M Unit f <br /> equested:From _ PST to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES A�A_�1.4� <br /> '��aialouwo Tiwrt <br /> oNUM TAW � PAWN l�i►cartvrvaaci� <br /> d WAM TM C oA GA� AL► G C MMP WN b r <br /> p UTTpplsopY papa" p bommom a WA'SnWAITIA TNlATIMT h ANT <br /> p WWWAL WAstz PA,autr G po"PA O tit TftWY"WCKN0A.Togs <br /> �t Ass arecsq M t rwo Uff APPMAIM 8np <br /> WILL ANo sgtla mos MeN AvA root 41"W•MONOAY4FmMY t:oO IW-i:OorM - EXoi 1JOMNa Nouo1► . <br /> t. List ap to tea addresses in the space above. ffieleat the types)of fNes from the Hit arbova by ohecMng the <br /> aPAroP box(es). At best one file type MUST be selected. <br /> O"s res$ranges Will Oo be l b*pr—for additional asalstance with fge addresses,oontect <br /> tit _4H!01 If or <br /> s .APpgtsltfons received alta'3:00 pm wgl be processed the next business day. <br /> 2. The EHD will notify the apptignt U any END tiles exist. Ane i <br /> •ppnaxhnately ten(10)days after n:cei of PPo ntment for review wig be confirmed <br /> days for review. awdul#iorl. The fibs will be held for a maximum of five business <br /> MPointments should be scheduled accordingly. <br /> A. A Pili that is actively beingubmIt vrowhefted t by EHD staff may not be immediattely available for review. A new <br /> application may be submitted when the tits is available. <br /> 4. Any file not returned in the same condition as released will be reorganised by EHD stall at the expense o!the <br /> apPllcant. Future fNe reviews br the isms applicant may requir+a a$93.00 deposit prior to review. <br /> L , 1 <br /> IoW« <br />