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10/31/2005 10:50 5102333' ARCADIS PAGE 01/01 <br /> 78/31/2005 09:79 4640138 ENVIRD►�NTAL HEAL-iTr —! PAGE 01 <br /> SAN JOAQM COUNTY <br /> Fwmo P EN 1TAL HEALTH MPARTMFm <br /> ' 304 t Webcr A YMue, CA.9$202-2709 <br /> Telephone:('209)46&-3420 F :(209)464-0138 b:wwwsjgvv.or0elid <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPt4CANT; EUSiMEWAGENCY: _ <br /> ADDRESS; O Sib -t(c.a <br /> P (,�: <br /> TENTAT E*Appourrair ate: = <br /> (Pfeaess dow 14 busl =or.fiver dote of appSc4en wb -�"1Erne orsip-intim!be <br /> 1B clfcq�BOX TO WE ME REST-f 9 FEE(G43tt OR cWLl OKY)_MQUEST PM)C ED W a BS <br /> SIGNATURE OF APPUCANT DATE a <br /> t tttrT LISSTRI I ori o ura t ❑Uri!2 {� . Untt 4jo utgt V. a tkdt s fl ter( 3 <br /> Fi-LE AgFtESS EM USE ONLY <br /> t k satv%d Nates <br /> q, G <br /> 561 <br /> l <br /> it L-1 <br /> 4. D r� / 0'��/ <br /> 6. <br /> 7, 2 �Y <br /> 9. - <br /> V] l21 lt. M <br /> ,Spec f c Daae name of InNfmation Ftaquested:I�rnm t� <br /> ENVIRONMENTAL HF-ALTN DEPARTMENT FILES <br /> ❑flocgma AenToot er D Sotto WAsn:FAct~rtiYW <br /> TAW NST)cx.VxUP- (LM c]Fova Fr�aj.r o WinFrt TRWaCULW P Sirs(Ho"44p) ❑ <br /> DAM <br /> Q TAW(lAOPMVMHfll`eiSNMAL.) 13 WOG KEftt <br /> 13 KWxo"WASTD GREPATClik ❑ kill a WAS-MWAMTF AtWW Puwr <br /> 13PE:.Intt�sb F�� a PWWMTatxadY Tott,m <br /> TAiT OOIBQt15'Pte' a Poou'l P LJ4m USE APAt=n0N sup <br /> to 1A®tcau Wire fAcr�rry ❑arm(Pt FasE s <br /> Wilt.AttD Ps�fF s�ArAn.aet,s t�Ort F1EYI�Y�I- 1doHo�vflfs�.�>X'�9 M�t�-fit - E%a�u�te 1iex�irs.- <br /> s of files from the JW above by cheokfng the <br /> i, lJst up to ten addresses tit the s�ara above, Select tt>a type( <br /> approptiat®box(es), At least one fele type MUST be selected- x d9 6 38 yr to the ad ross <br /> appro t o box._ Address ranges txWl not be accepted—for addl l asslstance Mutt file addmses,eor tct <br /> jnd;cathe[%JD.Application r+ecelved after 3;00 pert will be proc¢ss*d the next bnsiness day- <br /> 2. Tha P-BD will n'ot'ify the applicant If any 6ND files ex%t. An appointment for review*111 be confierned <br /> mpproxintately ten(f o)days e!fter reeg,,V of spplicatRm. The files VAH be held for a<maXimuth of fine business <br /> d#s for review. Appointments ehoutd be scheduled accordingly. <br /> 3. A file that is actively being worked on by Et{D stoff may not be imnnediatclt available for Ill A tieW <br /> application may ba submitted when the Me is ava7able. EHD staff stthe expense of the <br /> 4: Any file not returned In the same condition is released wWl be mManized by <br /> appliaarit, future file reviews by the same appl"nt may r*qu'tre a 93.OU depositprlor tv review. <br /> 1 � <br /> �+o.a-0z�o6 <br /> ,snuca , <br />