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NOV-30-2001 13:11 P•@i/o l <br /> SA` 'OAQUIN COUNTYPUBLIC HEAL.T , i�RVIC�S t�n,� �• :.M,. <br /> 6?LZ • " E hNVIROAIlII ENTAL HSALTH DIVISION / <br /> 304 FAST,WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 91102 <br /> (209)468�3429 <br /> U3LIC RECORDS RELEASE APPLICATION <br /> ._ .._.C,_ _ S i� $1I51Nl;SSfRGtrftCY G r �- � J' �—1 r ';``' ;;=j 7� <br /> AQDR�SS Q� C- G 5 ' El nI�r '! UL <br /> �J i�. <br /> ttolue 1 - FAcS1MILC/— -�l - S5 �__L4L L Gl <br /> A;"~TJsNTATIVE'APP01NTMiCrzT GATL' 1)-- 11' Q jT <br /> tPlcasa qA0e J W 10 DusinC:s days from JaSo of sppliralion Lul?milial <, <br /> CHECK[ii?XTC?,CXPEDIYE>�Q41U1 T-$ 7.04 FCE-RLQIJ- 7 PROcLs5�[]iH 3 DClSI11l:SS>7AYS <br /> �aNATURt OF APPLICANT � <br /> • DATE 13- p <br /> FILE AOORC5S 7314 SDS CHO$TAVI=US ONLY <br /> PAOCRAM CLEMC-t �, ;uEARCI-I <br /> '^"'+� <br /> ENVIRONMENTAL HEALTH 01ViSION FRES <br /> UN01-:RGRCIUNIO TAr4lr,(UST!CLE0.NUP s(re.(Los] C] Hou-S,I'!G ABATEMaNT 0 50UD WA.S'rE r•ACILITY <br /> E$ 0*THER`cI—ZANUP SITE CNON-LOP} L] F000 FACILITY <br /> 11A11}9FZCrR0UKD TANI<IM0AIIYGRING1Rr.kouAL d 0 SOLIR WASTE YEHICLL- <br /> HAZARDOUS WA. m GEIVEJ7AT0g ) DOG KENNEL b DAIRY <br /> ® <br /> 11r-RX: PERM17T D FACILrryQ CHICxEN RANCIi O PKG TREAc7MENT PLANT <br /> D <br /> TATTD f13t?t)Y>'�IRCiIrIG tnoTwHoya 0 PUMPER TkUCJS{YARbfCHEMTOiL>w't5 <br /> 10 <br /> C3 MEDICAL WASTL PACILrrYCI POOLISPA <br /> PUBLIC WA'r-$Y& 7$l{ O LANO USV-APPLICAYIOH SIT $ <br /> M"r--Ft(PLEASE SPECIFY A$oYJ} <br /> �- List up to MIq adClrC55cs in the space above, Saiect the W*)of files from the fist abAvo by tttcck`:rng <br /> WO appropriate b0X{e5}. At least one fiic type MUST be selected, Fax to( 09 4s4-U'f 8'�or►nail a the* <br /> address i diCated ab ve. -- <br /> 2. EMD wilt-hotify the applicant if any I=HD files oxist_ An appointment forrcview will be 00nfifmed <br /> approximately five business days but no 121cr than fen (10)days after rec:rlpt of a}�glicClliarti, fifes <br /> TI�c <br /> Will bo bald for a maximum Of five business days for review, Appointm - l is <br /> according y. el a af`toGid be scop. <br /> ed <br /> 3 A file that is actavcly being Worked on by END staff may not be immediat <br /> applic$tiOn May be 4U8Mit1Qc1 whon the file is available. 01Y arra{{able[Or rcvlcw_ ,4 new <br /> 4• Any fila not rcxturned Eli tJi sarnm concJ'IJivn as IrciCANCa will be rrarganitcd by EHD staff at t1le t <br /> 5. of the agplietlgt. Future flit-Ceviews by the s.Ytiic applicant may require a II7.0J3 deposit prior J ox—pen e <br /> "f F,NTATIVE appointment dates must be confirmed P'Ir-wit1=2iD staff. <br /> s w. <br /> ApplicationS received after 3:00 pm will be Processed tho next business day, <br /> CONFIRMED APPOINTMENT DATr- � <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX ItdfTIALS <br /> RlwVI�WE1 YES <br /> REVIEW DATE <br /> TOTAL P.01 J <br />