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' 'FL. 1 GIVvl(�UIVI"ICIVIHL 'min No, 1391 F• 'I i` UL <br /> eb, 28. 2005 9,08Rti94t) 0 <br /> t:HL!LV► NUMdte <br /> ynl�,� clV�u SAN JOAQUIN COUNTY <br /> D ENV1R0NTdF.NTAL HFAT.TH DFPARTMFNT <br /> NtiJC✓Cz:'�v�ieLlC, P ktJG>', Stccktony CA 95202.2708 <br /> Telephone: (209)468-3420 Fax,(209)464-013$Web;www,sjgov,org/el',d <br /> EfdVIE,Of�P�(�f T HFA!LTH PUBLIC RECORDS RELEASE APPLICATION <br /> --- <br /> APPLICANT; L-/y ` �?(J HU31NES3/ACENCY: M l t l�p� C.nuSU 4 �!G <br /> ADDRESS:_+4(I �. (ZA MC24 vt AVVr 5(1� `4014 f /"L P N A- CA Ci1Z9 749 <br /> PHONE(1): —]'51 r R9 9}"1 141 5 PHONE FACSIMILE: <br /> TENTATfVE*APPOINTMENT DATE: w.J►I-C� 11me: �'f7� I CO PM <br /> (Planta allow 10 Wginess days from date of application submittal-"Tenlative only-must be confirmed) <br /> ❑ CHECK 13OX TO LXFEDITE Rr=gUEST-SA3,00 FLM(CASH OR CH9CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Y��%� � DATE td)��z�i�at3�` <br /> UPttT OIS 1 tu8u fiUi 4 0 Unit'l 17 Ut� =rs!3 ` Gnit d Ll Unit 6 0 Unit B El Other(eloctronlc(llstslmaps) <br /> FILE=ADDRESS w { SE ONLY <br /> $trvstalr Street Name City i .. <br /> N VJ 1 s 1. <br /> dIF 2, 2. <br /> 4. ,` ' <br /> Air _1L <br /> c <br /> ia. <br /> Specific Data Range of Information Requested:From A195_ wo t�+r <br /> x. <br /> E=NVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,J`1�r�UNNDERGROUND TANK(UST)CLEANUP SSITE(LOP) G HOUSING A9ATWM NT 0 SOuD WASTE FAauiY/VFmCLE <br /> Cl LFFR CLeANUP SrTe(NON-LOP) In KOGb FACILITY 0 WASTE TIRE <br /> .C,40t r)W KERNEL 0 DAIRY <br /> DOUS WASTS 05NQRX , 0 GNtck RANCH L WAS111WAYpk iAd'ATW!ArPLANT <br /> 7MRED PERMITTED FACILITY d AROTELIHOTEL ❑PVMPER TRUCICNARD/C?1EM TOILETS <br /> O TATTOOMODY PIERG!NC 0 P0009PA D LAND UsE APPLICATrON SITES <br /> 0 MkipICAL WASTE FACILITY V OTHER(PLFASF 8PECIPY) <br /> __ _-. ... wn ... •.wn�a• OVn111nIV0 NAI In Ave <br /> 1. List up to ten addre"48 In the space above. Select the type($)of files from the list above by checking the <br /> appropriate box(es), At least one file type MUST be 6919oted. Fax to f 091464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for addhlonal assistance with file addresses,contact <br /> the EHL), Apnlicatinris recelVed after,-3:00 f m will be processed the next busineSe day. <br /> 2. The EHD will notify the applicant it any thin files exist. An appointment for review will be confirmed <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> dove for review. AoDointments should be scheduled accordingly. <br /> 3. A file that is actively Ming v;,3r;:ad cn by E.4D staff may not be immediately available for rev;®w. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condltlon as released will be reorganized by EHD staff at the expense of the <br /> app;::&rw:. Future filz ro=rieV.fi by tele fiarrc appllcjInt may require a$93.00 deposit prior to review. <br /> IL eHo�+-�-0ae <br /> 11121,N4 <br />