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r +•-•/ �.- +.+ iv.au �i f. r V LVJTI 47GVJt...1GIYLGJ 11YW I PI4.{L 4t <br /> IF <br /> �I <br /> r <br /> F'o q -Iti..01 <br /> Csr3Y LOG NlIM601 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION � <br /> 304 EAST WERNR AVENUE,THIRD FLOOR <br /> STOC ETON CA 95202 <br /> (209)469-342.0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT _J 1e ti.. I�59lAGIvitiICY,_�/rvJl <br /> PHONE <br /> TENTATIVE*APPOINTMENT DATE THAE <br /> (Please eve 7 to 10 bw%1A ass says tram data of a.pptl4la an submittal} <br /> ii <br /> lit <br /> CHIECK COX TO EXPEDITE REt;iD£ST S7 t;�p.EQIIE/ RCC �D IN a BUSINESS DAYS <br /> I <br /> $!Gl►IATtJRE OF Air Pl.(CA DATi� - <br /> �f <br /> FILE ADDRESS t <br /> I <br /> r_2274jzgtic � - <br /> ENVIRONMENTAL 141 ALTH DIVISION PILES <br /> 4C-UMDERGROUNO TANK(LIST)CLEANUP 31TE ILOP) 0 HIGUSINO ADATEM£NiT i 0 SOLID WASTE FACILITY <br /> O OTHER PLAANUP SITE(NON..LOP) 0 FOOD FACILrrY � rJ SOLID WAM VEHICLE <br /> a UNDERGROUND TANK(1140Nl't"c7tZlt OIREMtOVAL) G 003 KENNEL M DAIRY <br /> Q HAXAA001 3 WASTE GENERATOR 0 CHICKEN RANCH M PKq TAMATMENT PLANT <br /> M TIERED IS KWTTE4 PAGILITY M MOTELIHt]TEL C] PUMPER 1XUCKlYARDtCHEN TOILETS <br /> 0 TA'I"r=SODY FHIRCtNG D POOLISPA 0 LANA#USE APPLiCATIQPI sans T <br /> M Mr;VCAL WAOTA FACILITY M PUSUC WAT9R SYSTEM � 0 MER(PLEASE SPECIF-Y ABOVE) <br /> 1. List up to ten addresses In the space above. select the type($)of files from the list above by Gheo#sing <br /> the appropriate boXteSj. At least one file type MUST be seleatei. Fax to (2€I9).464_,01 ,Rr mail to the <br /> addr*03 Indicatet3 jig ave. <br /> 2. E14D w1I1.notify the applicant If-tiny EHO files aalst. An appointMant for review will be confirmed <br /> ZIPPrcxx.irnataly five business days but rto later than tent(10)days after receipt of application. The files <br /> wilt be field for a maxim am Oi'five business days for review. Appointments uh0old be scheduled <br /> accordingly. <br /> 3. A file that is actively baing wmttd on by END staff may riot be Immediately available for review. A new <br /> applieatlCin may be 5ubmil:W when me file is available. <br /> 4. Any file not i`eturned in the same condition as released will be rigorganized by EtiD staff!It the expense <br /> of the applicant future file reviews by the some applicant may xequirc a $78.00 deposit prior to review. <br /> S. *TENTATIVE appointment+dates must be confirmed w1th EH[) Staff. <br /> 6, Applioations rceelvad after 3:00 pm will be processed the:next t uslneSS day, <br /> ;i <br /> CONFIRMED APPOINTMENT PATE _ 3 0Er <br /> TIhAE _ <br /> DATE CONFIRMED PHONE " i'Ax F 1f3S1T IALS <br /> l <br /> REVIEWED YES NO REVIEW BAT;EE <br /> m 14 elm 4 <br /> _ � s <br />