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10/31/2005 10: 50 510233" ARCADIS PAGE 01/01 <br /> 10/31/2005 09:19 4640136 ENVIPOMY1ENTAL HEAL. PAGE 01 <br /> $AIV JOAQM COUNTY <br /> 304 Fest Webcr Avmae, r_R=—Stu�CA 95202-2708 <br /> Telephone:(209)468-3420 F :(209}464-0138 h:wwwsjgov.org ehd 120613 <br /> PUBLIC RI; ons RELEASE APPLICATION - <br /> APPLICANT: nustue33tAGWCY: S <br /> ADQRESS� <br /> PHONE(i); <br /> TENTATtVE'APPaniRtFrXtrloAiE: <br /> (Please -ta bunincss aaty;MroRt dere of ippSCaTiM -'r five only-must ne umed) . <br /> pe❑aceaxTo�Fvrt>_R�2ufiaT.ts aaF-s�(casttoftatEqcc�Yl-acau�TProoasseatt+asustrtsssa4vs <br /> SIGNATURE OF APPLICANT DATE a <br /> wa DMTRf6U r" O UrA 1 ❑Unk 2 UrA4 Untt 6 ❑ WK; ❑ Ott�+r(eleckvMMtst-hna}za) <br /> FILE DRESS EHD USE ONLY <br /> _ straetf ' sueclNxrne . <br /> itit <br /> G <br /> 7. 2 <br /> tr <br /> 9. <br /> . ..Specific Aare Range of Irt QfroQtion Raquestad:prom to . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> TNIK(U9TJ p.[Nrt!rSPTE(�l ❑YA6arflt0H ❑$alp WAs,<Fu✓<rrMA' � f �'- <br /> exaAxv+Sr}sfualiAP] r1FQWFAMAIT 13WAMTRW <br /> .❑UiK Pr.:toumTAW(Mgiir 4VlAL) ❑Doc Kms. ❑DWY <br /> R J"Z% IIOV wXM G&EPATOfi ❑p�-,1Rulcst 13WtatEWAYStiTi Ai'1F6r.-tPuNY <br /> ❑Vic=PW.at1rso FACanv ❑ pu+crEttTRtxrUi',AI+>NAt TouFts <br /> 6 TAi Oasoty P03cs'n .0 PoaclSTA r7 UrrJ USE MPucAnoM Snb'a <br /> L7 Xmr_&WAsceFAcanr ❑O dm(£tEAsr.Seo�lm <br /> W¢ttAmSiswpsngTRmo=AnkYALMAroRReYIEYr 16a1oAVFkpA1tOafA<d - E�wawttc�mAYs. <br /> 1. List up to tan addrosses(n the space above. geleot the types)of files from the list above by checking the <br /> 6�-0138 or <br /> appropristo box(os). At least one file type MUST he selected- Fax o(2091 amail to tp}e ad rose <br /> indicated above._ Address ranges w91 not he accepted—for add iUanal asr+lstance witfi fila addresses,contact <br /> t3:c EHD.Applications received after 3:00 pm W%be pracessed the next business day: <br /> 7_ The EHD will notity the applicant If any E14D files exist. An appointment for review will be confirmed <br /> nppro)Zimately ten(III)days after recelpt of application. The files w40 be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be Ir mediately ava Mable for review. A new <br /> application may be cubmi ted when the fde Is ava sable. EHD staff at the expense of the <br /> C Any file not reWmed In the same condition as relas®d wilt be reorganized by <br /> applicant, Future fie reviews by the same applicant may require a$93.00 deposiitpdor W review. <br />