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SON SAN,JOAQUIN COUNTY <br /> i _at taL <br /> EN , <br /> VN�1T17�.r111J1`7r..3J HEALTH L`EPARl�ir7rc�#��:1. <br /> 3(ZWeber Aire P Floor Stockton,CA 95205 <br /> APS 2 3{ 468-3420 Fax:(209),464-0138'Web:www.co.san joaquin.ca:uslehd <br /> I 'EALTH PUBLIC RECORDS RELEASE APPLICATION <br /> j <br /> APPLNANT. d6-Se lest& BUSINESSIAGENCY. F�J6, /tu <br /> ADDRESS: 2s,90 A). 70 7 � <br /> PHONE: 2 C>�1- 2 35,e iS/b FACSIMILE: ,�L oet• 13q- (247 45 <br /> ENTI�ITNE*'AF'PtHt[1 MEN1 DATE: —rum: <br /> (Phase allow 10 business daysfrota date of applic uonsubmittal} <br /> i <br /> fI iE C SOX TO EXPEDITE RECtUEST-$93.80 FEE-REQUEST PROCESSED IN 3 BU$tNI_SS DAYS <br /> SIGNATURE OF APPLICANT G�i�, <br /> _-- DATE yb 3Ay <br /> Depadmea use Only <br /> FILE ADDRESS UNIT <br /> 1. fiaeet x a unit s <br /> 16%%6 IIAAeAdl je)2 AJ) <br /> 4: J R 0 <br /> nd <br /> & suets 1 f� p <br /> `Ur <br /> it 3: <br /> t: s. street 7 E d to 4tW 6 P F <br /> i <br /> z. st<aet 713 t d t° i 4 <br /> a: see v is <br /> Utut 5 <br /> i <br /> 10. sleet y <br />{ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> MIGROUND TAW(UST)CLEANUP srrE OLC ;Z�KOUSING+ABATEMENT Af SCS WASTE FAdC#t.�`[Y <br /> F <br /> ER CLEANUP SIT ON�t�j FOOD FACILITY A"SOLIDwAS'TENEHICt-C <br /> ERoRouNDTANtG�oNiToPitiommoYAL) P poo. CENNEt.WASTE GENERATcxt CHt4N RAt{gi TRExTMENT PLANTED PERE�[TTTED FACILITY MOTELIHOI EL ,l 14lPER TRUCKIYARDtC1*U TOMEMTEtBoDY PtERCiNG PA LAND USE APPGiCATt{ SITES <br /> MEOtCALwAS'iE FAIGKM c• OTHER(PLEME SPE£.yFX} t?Y ► _ S Ftr�2 St? 5 <br /> up to ten addresses In the space above. Select the type{s}of files from the fist above by checking <br /> the appropriate box(es). At least 000 file type MUST be selected. Fax to(20914"0138 orsnail to the <br /> address indicated above, <br /> 2. END will notify the applicaint If any EHI files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(30)days:after receipt of application. The files <br /> wiltbe held fora maximum of five business days for review. Appointments should be scheduled <br /> G accordingly. <br /> 3. !Mile that.It ailively being worked'trn by EHD staff may notbolmmodiatelyavallable.for review Anew <br /> application maybe submitted when the file is available. <br /> 4. Any file not returned iso the same condition as released will be reorganized by EHO staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00.4posit Pdor to review. <br /> S. *TENTATIVE appointment dates must be confinned with EHD staff. <br /> 6. Applications recehred:after 3:00 pm will be processed the next business day. ' <br /> GC'� tFdMl1Pp!CiNTMENTtiA'fE <br /> r 3 r <br /> = . . PONE.VAT FAX'.: iN1T4. <br /> f EYiEY11E[ _ YES lI{) <br /> R iMeW DACE <br /> t;tta+ta-0x�aos . <br />