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12-07-1599 4= 1 ops i 1=l?fir l vii tir L _•. <br /> ldlCkl <br /> t1 ,. „+rte <br /> IG pnTF REf�E} SAN JOAQUIN COUNTYPOBLId HEALTH SERVICES <br /> ENVIRON HEALTH 131VISION <br /> 304 EAST w R R AVEAtt3E,TWRD FLOOR <br /> 5rociiTON CA 9-%= <br /> ' (2Q 46$-3420 <br /> PuBlic RECORDS RELEASE APPLICKnON <br /> -� (,,H . <br /> apPt.�prl7 *►`"•4 cr... 5�tvt,a�. Oi{StNES3tAC,&G'l <br /> 3 CA <br /> AODRESS ` r <br /> r FACS37Ad.E <br /> PNQifE('7T, <br /> is b,raC, 7m.L =�'� <br /> '};ENTATME'APPD WrMEN3 DATE lrorndxdc at appy <br /> cation suWw”) <br /> (�faar�a giwa 7,W tC tsoll'+�> s dagrs <br /> - @SSED ti 3 RUSUESS DAY$ <br /> - FSE-ra GHECK BOX TO ExlxM REQUEST S116 <br /> T <br /> �rCa �- iyATE � <br /> SIGNATURE OF APPLSC-ANT <br /> • Fit- A!#DIi�S+ <br /> E. ( <br /> �. <br /> �V1R043M AL 1•;EALTH t]lVlStt]N FILES <br /> 4 fl NAL1SltSG AHA V :+Ot-1D WASTE rA!CUffy <br /> L1tdD1rRGR0et11D TANK(UST)C4EA."t�S its) l] FOW trA�Ctt.1TY n 13 EWWSWDWwSSE <br /> 0 �R CLEANUP SE <br /> pHTO1vAL) t] DOKERNEL G # CETgA��T pl ANT <br /> g. RGitOUND TANK(M4n CK�EW RAWMA ❑ Pt� Tf H <br /> EM <br /> CK HAZArN�Cq$WASTE GmERATOR p NO-FkUHOTELM LAKOUtLAPPLACATOfteml <br /> 0 I7 KLO PERhAn1tD FAC31T7 4 p pO0LiSPA 0 0-01F,R IPLZA3Z 3p CI <br /> C TA XTOG aagpf pfirC MG C] pusur.WATER SYSTEM <br /> Q MEDICAL WASTE FACIUryof files from tho list above by checking <br /> above. Select <br /> the type(S) g'1 <br /> 3, List ap tO tGrf$tltlrasses in the Spare MUST be seisGt*dFax to 09 <br /> the app4vpri�b*x(ea). At'Ieast orf*file type <br /> aadr�es,e s d- a �rfirnant icor review wig contirrried <br /> 1;cant if any EHD files exist Art ap tla attar rscstpt appiicaoorr- The flies <br /> 2. E}lp�,,nli�gd�r[x the aiSP but no later than ten(1i?))days <br /> approximatelyfive bu!;ioe!! days rcvrew- �,ppoinwer;ts should be srtrtdulzc! <br /> Will be held Por a maxlmu:ri'nf fitfe twsinesa�dsrys for ,available fog review. A naW <br /> acrotdrn$lY• vrorlced on by END staff may teat be!Mmedixielyr <br /> 3. A file that is al:Vvvly being, file is ays%Wkle. reorganized by EHD staff at thy►"peose <br /> application may tse�ubmk"d when the <br /> s carrditiolt a5 rai as4d wtH be reO�ire a$78.00 depoalt prior to review. <br /> 4. Any file not raturrred in the sart t1Ra same apPlicant'nay rev <br /> at ttre applicant. frfture t7lb reYle t be confirms w"EMD staff. <br /> 5. �{EiriTATf�TE appointfnenk dates pm% !U be process ibe next business 1Y• <br /> 6. Af!Pi `ons received Aftm.; 3: Pm <br /> f� " i f cv� 9vt1 t t+"�ti��k 7 a�,_'., v ' ,�': x �:Y.v• :' :.L,. <br /> i�,�y!'Zi��r,� ,�f" •:�•,.'�`/C�mZ�-�"�7Zk rj i '� _�fs�,�t,-io:�;E ,If, <br />