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�11 SID - <br /> � 4HU LVti Murn�ic <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WI=SER AVENUE) , THIRD FLOOR <br /> S1E�` � Sroz aN CA 052G2 r� <br /> ( ) 46s-3420 <br /> ' PUBLIC RECORDS R�IL-l~ASE AVPLICATIO <br /> APPLICANT sus+',lvnnt<ssiRGerccY <br /> ADDFtF-33 <br /> PHONE_ FAr-.sLwLE {{ 3(} <br /> TENTATIVE,APF'rr31PiT1NEPYfCATi+Tutf5. i Tiwz <br /> (?1a give 7 to'10 b�mass days from date of application swwrsitw) <br /> � �e�t �.�. ��- �L�S ire Gti�►��1'��. Sc5ov+2.Y{ �1r�•.h,�� <br /> C8LG.K 6Qx TO LXPEar)n'E RE( Lu=sT-U7.4o r=--REQUEST PROCESSED IN 3 1SLSINES$GAYS <br /> s1GNATUIRE OF APPLICANT DATE I& <br /> FILE ADDRESS THIS SIDE F-Ho STAFF USE ONLY <br /> PR9GRAM ELFMENTS SEARCH <br /> 0 53 0 -38 f <br /> � 439E DE p ' <br /> ,►.�a7 t cc �`ti#rtL d- N04 AHrSLEC� 1oxu Y"VIRONMENL �LTHHDIVIION PI <br /> G UHDERC ROUND TANK CNBTI CLFA_NUP S=TE(LOP) b xoUSING ABATEMENT � 5G7LIa WASTE FACILITY <br /> R OMiE;R CLEANUP SITE(NON-LOP) ❑ Fa0D FACILnY ❑ SOLJO WASTE VEI11CLE <br /> ❑ UNDERGROUND TANK CMONITGRiNWRZ�MOVAL) M DOG KENNEL O DAIRY <br /> C3 HAZARDOU3 WASTE GENERATOR ❑ CHICKEN RANC11 O PKgTR ATrpMF.NTPLANT <br /> CJ InEREDPERNIMEDFACIiJTY ❑ MQTELihOTRL n PUMpBRTRU CWYARUICHEMT01L-ETS <br /> M TATrQQfHQDY PI=IRCING 13 POOLISPA ._... LA.IW USE APPLICATION SrrF-S <br /> 0 MEDICAL WASTE FACILrrYPUBLIC WATER SYSTEM l=F2[PLEASE SP2C]FY ABOVE) <br /> 1. List uta to ten addresses In the space above. SClect the type(s) of files from the Inst above by checking <br /> the appropriate box(es). At least one file type DUST be selected, E 2 3 or mall to the <br /> address ir►dicated above. <br /> 2. FMD will notify tho applicant if any FHD files exist. An appointment for review wit] be confirmed <br /> approximately five bysiness clays but no later than ten (10)clays after receipt of application. -The files <br /> will be held for a maximum of five business days for review. Appointments should be srhecluled <br /> accordingly. <br /> 3_ A•files chat is actively being worked un by LHD staff may not be ImMediataly available for review. A new <br /> aPPhcatiGn may be submitter]when the file is available_ <br /> 4_ Any file not returnees in the carne ConCltion as released will be r0or_qanixed by FHD IStaff at tho expense <br /> of the applicant, Future fie reviaYrs 4y the same applicant may require a$87.011 deposit prior to review. <br /> 5. 'TENTATIVE appaintrrlent dates must be, confirmed with EHD staff. <br /> .6. Applications received after 3;110 pm will be processed the next business day. <br /> I <br /> ICONFIRMED APPOINTMENT DATE TIME `— <br /> 'DATE CONFIRMED PHONE FAX INITIALS <br /> i <br /> PREVIEWED YES NO REVIP_W DATE; <br /> 74 M271W <br /> i <br /> � !E �{ �FQF '0!'11 )ii��S�' ,a ��;�laDlly. 'il I �al'I NJ��r`� :71 IfIf1Z •FZ• il�f <br />