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-LJ'J' I LLU iu-• --. _"�1 'LlJ I'.IJ YJL' ��Jl <br /> f1tJll''i'-f-Ll'JV:JIJ 11�.J.. l'OU:1.,t l• I W l i'il t•i1-t-i "J�L).J/ 111'�. ` d <br /> 08-14-2M 10:29PM 400 TO % 1559. 687126 P.O: <br /> (A1 E RECD t �1.90 <br /> (��\\VVVVIIII ll[�� <br /> SAN..FOAQUIN CDUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WrIgER AVENUE,THIRD FLOOR <br /> ST(209))4 CKrOMGWh3dA 220 42 <br /> Nj HEA1-�H PUBLIC RECORDS RELEASE APPLICATION <br /> 77711 PE L T '75574 E'YIC 1rtlswessrACENCY <br /> ADonEss .cam <br /> PHONE J J 1 Z u� 502.1 FwC31MlLE • Leg 171 ZL <br /> i TENTAT[VE*APPOI LIENr RATE a TIME \0 <br /> i (K oase Sive 7 to 10 puss ss days bVm datl of opplleaum submittal) <br /> CHECK BOX TO EXPEWE REQUEST-$87.00 FEE—REQWnST PROC$SGEO IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT, =� � DATE ��lsx� <br /> ` <br /> FLF-ADDRESS 7M S09E EM STAFF LME OWY <br /> PAOGRAM El EM73 BEAF= <br /> OS COv .29 i <br /> ✓3Sa-Sr � o. a t Z �o D <br /> ✓ i ; of b <br /> �3 5X-7 - Z o Z: <br /> s o S- C 4J O S <br /> PY CI <br /> Ira\71,17 C4. 741A <br /> LuKaPRGRmjg) <br /> ENVIRONMENTAL HEALTH DMSION FILES TAM((UST) LEMup srm(LOP) O HOU:SLNG ABAYZMENT O 50LJD WASTE FACRJN <br /> OTllsx CLEANUP SITE(NO114LOP) G FOOD FAMM fl SOLID WASTE VEHICLE <br /> U"DPRGROUNO TANK NGAEMOVAL) n DOG MUN[i O DAIRY <br /> JR HAZARDOUS WASTE GENGMT+OR C MGM RANCH O PKG TREATMENT PLANT <br /> P TIERED PERMITTED FACNJTY O NOTELMOTP.L O PUMPERTRUCK/TAAGFCHE1ITOkM <br /> P TATi00=DY Pf.St=G D PdOLlSPA O LAND UW APPUG►TI01 SITES <br /> O MEDICAL WASTE FACILITY G PUBLIC WATER SYSTEM 0 OTHER(PLEM SPAYAHOYEi <br /> USE up to tan addresses In th&space abave. Select the type(s)of IlLaG from the IIsi above by thacking <br /> the appropriate box(es). At least one,file type MUST be selected. Fac (209)4640138 or mall to the <br /> address Indicaded above. <br /> "D will nottfy!t applicant if any EHD files exi3L An appointment for review will be conftnrled <br /> approximately five business days but no later than ten(10)days after receipt of appftatlon. The tiles <br /> I will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> '. A rite that is activety being worKed on by EHO Staff may not be iirtmediately available for review. A new <br /> application may ha submitted when the file is WWkbl*. <br /> 4. Any file not returned In the same condition as rokand will be reorganft6eby EHD staff at the expense <br /> I of the applicant- Futuro file reviimn oy ift same applicant may require a$87.00 deposit prior to r„ri4lw. <br /> 5. "TENTATIVE appointment dates must be conftrrned with END staff. <br /> Applications received after 3:00 pm will be processed the next business day. <br /> i <br /> CON FIRMED APPOINTMENT DATE TIME <br /> , ATE CORFIRMED PHONE FAX INITIALS <br /> F <br /> J. <br /> 1RFVMWED YES NO REVIEW DATE? <br /> 19.0 <br /> TOTAL P.81 <br />