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ENVIRD*IMENTAL HEPLIH" <br /> i31 E331 903 15:15 4540136 e�n�tioc Guiana <br /> � AN JOAQUIN C.OUNTYPUBLIC HEALTH SERVICES . j <br /> ENVIRONMENTAL.HEALTH MISIO.N E <br /> 304 !, WT YVSSFR AVENUE THIRD FLOOR <br /> AW.; 1.110 STacKrON CA 95202 t! <br /> (209)468-3420 <br /> EN TROP„ IElW- EAL` UBUC RECORDS RELEASE APPLICATION <br /> ATUC N Ii~ 1 N I BUSINEt+StAGlitCY. A _ _ <br /> t}RE S M 100 <br /> QNr_ � +„y X F+4LSIM71 E <br /> TIENTATI APPOIWINIENT VATZ <br /> UG. 2- Co2005 Tmrr �� : 0081'1"1-- <br /> (Please Qhro 7 to 10 buskmss d*ys freer date of apiAlration submittal} <br /> 1=CK Bax TO Ex IT1»RUOULST-$89.00 PEE-REQUEST PROCESSED 114 3 BtlSMESS MAYS ; <br /> *S GN W(E OF AP LICA <br /> DATE �8S <br /> ' I <br /> I <br /> FILE ADDRESS THIS SiaE WHD&TAPE USE ONLY I <br /> PROGRAM SLF-ii=-ASZCIL <br /> tai ne, ra C� <br /> Ali, <br /> ENVIRONMENTALHEAL.TH WSION FILE$ <br /> ! lIN C.F ide YA K JUST)CLEANUP'St l'E SLOP) ❑ HOUSING ADAY�14tENT 0 SOLM WAST t FAC1t t'�Y <br /> pTH CL.irA14U S lNt]N•LQP# E3 FOOD FACILITY 0 SOLM WASTE VEMLE <br /> I UN �C-1:10 D TA K(M0Htr0RINGIF XM0VAW C1 000 KENNEL 0 DAIRY. <br /> 4 US WAS CFJIERATOR a 010MN RANCH O PKG TREATIJIENT P1.AbTI <br /> 17E pERIW1TrE0 AGrlrhr CS M4 I1iiOTt=l, o F mPen TRurwvARDfc�i i TOts.>TtS <br /> TA: OR100y rrSIR ING b POOLISPA to LAND USE rAPPWATION StT`iS <br /> #ME6AL WASTE F.4 ILrrY <br /> Q OTHER(PI_05E SPECIFY ABOVE) <br /> 1 Ust rip to vn addresses In tl1� space±abova. Seloct the type(s) of fifes from the Ii$(above by cheakin�' <br /> j the apprtr Tiatc box(cs). At Ica$t ono file type MUST be selected. f ax to 209 A64-0138 or malt to the <br /> address i diel#ed above. . <br /> END will n lily the appiiasnt it any EHD files exist. An appbinidient for roview will bL canilrmcci <br /> approximz toly five businoss days;buk no latarthan tail•(10}days aftf'r raceipt.or application. The riles" <br /> t <br /> will ba hal I for a maxlmym of five business days for review. Appointment&shgvtd be nhedulad <br /> according y. <br /> A file that A actively baing worked on by_FFHO staff may nok be iriuriedlately available for review. A new <br /> appl'rcatio mAy be,SUbrriittad when the file Is available. <br /> 4 Any file ril it returned Ih the samq condilicti as relearsed will bt reorganized by EHD stafr at the exponse , <br /> of the app scant. Future file ravlowrs by the same applicant may require a$119.00 deposit prior to revlcvv" <br /> 5 . MNTATI IE appointmotlt dates mast be confif'med with EHD staff. <br /> Appltcatio s r.co0vad after 3:00 PM will be processed the next business day. <br /> 4 <br /> QN IRMED OINTMENT DATE, TIME ' <br /> j <br /> TE f10"F1RME4 ._.�- -- - PHONE FAX INITIAt.,S <br /> } ED YES N4 RIrVIEV1r i71AT>r ' <br />