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-•-Iva r, Zd, ZUU/ d;4UAM.. -Advanced Ueotnvi ronm.ental No, <br />a _ <br />DAT, FtECEtYi=ti AHD LrJG NUM6ER <br />SAN JOAQUIN COTJNW <br />=� E+ NVI ONMNTA.L HMTH UEP,AIt'T11ENT . <br />304 East Weber Avenue, 3�door, Stockton, CA 95202-2708?00f <br />_ Telephone: (209)'4,68,3420 Fax., (209) 464-0138 Web: wwcv.sjgov.ocgZeiid <br />NV: qql <br />PUBLIC RECORDS RELEASE APPLICATION <br />ApPt.•1GrNr.1 ��7• 01#;,_.,cy.cI1 Ar4 ,/�susiNEssracEN�Y; �Q <br />vin <br />ADDRESS: g3 1 5j}A1N oW SroC Krdi/ Q,4 <br />PIIOKE (1):\'2c'9) t rrl - 1 n ok PHONE <br />Y <br />TF,NTATWE* APPOWTUENT DATE: Time: <br />(Please allow 70 business days from date of application subtrdttal • •Tentativie only � must be confaned) <br />0 CHECK BOX TO OTt3DITZ REQUEST • 105.00 <br />SIGNATURE OF APPLJCANT <br />FA <br />(CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUS1N $$ DAM <br />DATE 3 <br />Efectronic information: [I List ❑ Ma.P — Description: <br />Specific Date Rang9 of information Requested, From to <br />tNVIRORMEHTAI, HEALTH DEPARTMENT FILES <br />A UWFpzr wmTAW (UST) Urmui, WE (LOP) 11 KYJsaic AgAsEmaj ❑ Sam WASTE FACW&C1011 <br />❑ Food FAca rr�r ❑ WAM Taxa <br />C3 Osi•iErt CtExxvP S� (i(or+-i.QP} o Doo d DA�r <br />-,14M RORetmd%utK ( Offii�aRlltrlR>;MNAL)A IYASTYNIA7 eKTRlIATµENT PLurr <br />[3KgAAMM WXSTE Oatr> xa:TOR O Ciit m R,wca <br />rl T&teuPERgnTEa FActm ❑ IdOMJH07EL ❑ PLwatTRuctuY,utv1(airm'Toa.�rs <br />❑ TATToo'soexP�+G 0 PooUS�A C7 LAW Us>;-AQnlc4VM ScMs <br />❑ MWOLW&srEFAMITY C30TPZR.(PLEAsEs aFn <br />YkLL AtiDSM'= Pmmw RECORDS ARtE AYM ML$ M RAWW - MOMAT-rMAT 9:00 Air '00PU •. lNMww }I01.70AYL <br />1. W up to ten addresses In the space above. 5eloct the type(s) of files from tfie list above by Chocking the appropriate <br />box(%). At least one ilia type, MUST L�0 FOlected. Fax to (209) 40-010 91MIJ 19 thq Address Indlcated above.- Address <br />ranges will not bo accepted — for additional asslstance with file addresses, corltad the EHo. Appllcatl0ns received Mar <br />3:00 pm vdll be process-ed..the..next business day. <br />2. No 1.HD will notify the appllcogt if any F -HD $Iet exist. An tLppolntment far reyiswwill be continued approximately ten 419) <br />days.aft©r receipt of appiicstion. The files v.All be held for a maArnum of fiv9 business days for rovlew. Appointments ' <br />should be scheduled accoMingly. <br />3_ Able that Is activelyheing woriccd on by EHU V.1W may not be Immedtately available for reviow. A naw app111;400 may be <br />s�bmltted when -the file Is available. , 1� <br />4. Any file not returned In the same condition as rolaased %111 bo reorganlzed by FID staff at the eXpense of tiro applicant <br />Future file revlews by the same applicant may require a $95.00 deposit prior to review., <br />EHD USE ONLY <br />�a <br />a <br />0 <br />