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04/11/2003 08: 29 209-579-,"?95 MODr-STO ATC PAGE 0)- <br /> �rll r. l�.- l�.,i <br /> APRT 0 2003 SAN JQAQUIN COUNTYPl16 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> t�JII�ES <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ,•'JILi�;I\l(�'I�:V� l"iI_NLrti STOCI<7oN CA 95202(.200) 4GO-3420 <br /> I <br /> c% ;L;►TISE�vIGES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Y (�, r Q ^ �`�l�4"1t7U51NES �� "e »>-.��.•�<- <br /> SlAGENCY <br /> ADDRESS Ill <br /> /A� ,A'- CSI <br /> PHONE Zv4 S L2Z - <br /> FACSIMILE Z_y`� C; -7.9 - 'ZTISS <br /> TENTATIVE*APPOINTMENT DATE �I/ZS D3 <br /> (Please Vi—Y —10 uuainasf Jays frogn date W applicat Oh :ubre l101) — q-d- <br /> I O5 <br /> 0 • ' <br /> G►1ECK[30X 70,CXPGDITE REQUEST-337-00 FEE-RCQUl:ST PROCESSED IN]UUSINCSS UA YS Wit4 � <br /> SIGNATURE OF APPLICANT C,, V a� /�,� <br /> DATE <br /> FILL'ADDfiCSS THIS SIDt.EI10 STAFFU:iE ONLY- w� <br /> a <br /> PROGRAM 1_LL'MENT5 SEARCH <br /> cb Z Z <br /> so r o A <br /> 9Q a <br /> n_ 5 <br /> �5 +SCnI --vf � - <br /> C c 1), �v-C-1-4, <br /> n1 I (Vd 7 1.�_ /10 <br /> cC, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> x0"UNDCRGROUND TANK(UST)CLCANUP SITE(LOP) O HOUSING ADATI`MENT <br /> EI OTHER CLEANUP SITE(NON-LOP) O SOLID WASTE FACILITYO FOOD FACILITY <br /> 0 UNDERGROUND TANK(MONITORING/RCMOVAL) O DOG KENNEL O SOLID 1YASTE VI_HiCLE <br /> 0 HAZARDOUS WASTE GENCRATOR0 DAIRY <br /> 0 T{GREO PERMITTCtD FACILITY O CHICKEN RANCH O PKG TRLATMEN'r PLANT <br /> P <br /> d <br /> O TATTOOIBODY PWIRCING 0 OL 0 PUMPER TRUCKWARD/CHEM TOILETS <br /> 0 MHDICAL WASTt)FACILITY OOLISPA uSPA O LANA USE APPLICATION SITC5 <br /> O PUBLIC WATER SYS.TtM 0 , <br /> OTHER(I'LEASE,.PEC(FY ABOVC) <br /> 1. List up to ten addresses in the space above. Select the types) of files from lite list above by chocking <br /> the apprtapriatc box(cs). At Icast one file type MUST be or selected. Fax to �,?09 4Ga-U I�Iti m;ti1 to rhe <br /> 7ddre5s indic�tcd above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for reviely will ba Confirmed <br /> approximately five business days but no later than ton (10) days after rec:ipt of application. The files <br /> Will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3- A file that is active( being worked on b EHD staff ma not be immediatul Ivailablr. ('7r ruvivw• A nuw <br /> Y s� y y <br /> aPNlication may be :ubmittod when the filo is available. y <br /> 4• Any file not roturned in the same condition as released will be rcorpanized by EHD ;:I.aff at the expense <br /> Of the applicant. Future file I-cviews by the same applicant may require Q :;07.00 dcGosit prior to rr;vicmr. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONC FAX INITIALS <br /> REVIEWED YES NO <br /> REVIEW DATE <br />