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10/31/2005 10:50 5102333" APCADIS PAGE 01/01 <br /> 10/31/2005 09:19 4040138 eWjpDt y1 AL HE4LIn T_ -PSE 01 <br /> SAN JOAQM COUNTY _ <br /> " EN YTiRONMYNTA.L HEALTH DEPARTMENT <br /> 304 East 'ebcr Avciluc, �, CA 95202-2708 <br /> R 0 <br /> Telephone- (249) 468-3420 F :(209)464-0138 Wb:wwwsjgov.or�Jehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: EUSNEWAGE NCY: <br /> ADDRESS; t7b ! -bt(� <br /> E l �^ <br /> TFYTATWe APPOuy']'4UNT DAT;: Y�stic: r <br /> (Please dow 14"Inc=ga r.fiwl dde of 2PPG=rVW rub -"rcrr Five WIY-inus! <br /> Q '/s dEC7C BOX TO DPEDrM REQUEST•$D?"RM(GASH OR cpmclC 0MY) FCQVM i priO SSim 1!t 313WIRMS DAYS <br /> SIGNATURE OF APPUCANT _ DATE <br /> Orb's'DtSTE WnQM O Uric 1 ❑Unk 2 CJL4Unit< Uatt E 81 WX 6 ❑ Oft'(aieckncUMisfs► 2M) <br /> FILE ADDRESS EMD USE ONLY <br /> Slut f stmd fJa a C4 <br /> 6. <br /> 7. XLI <br /> Ia. �� M <br /> spedfic pate Ramie of lnf nmation R,equesbed:prom to <br /> F_WMONMENTAL HEALTH DEPAMWENT F11-ES <br /> a� �F <br /> TAW P51 MAtM"P) o w .. <br /> TWX <br /> Cts sm(N004-cpl C]Foao FAM r <br /> i� TAW(MOtiCrOMO/�Ao t3 DOG Kmaw- U DARY <br /> C3 F{AZA wS W ASTF C>E RATOF: ❑ RAMM ❑WTz%WA;�m'zAtWzh-r PLWT <br /> ❑1z�=Parts]FAcury ❑m6rah40 is 13 pt ERTRttCi�1C 'Ibft ET5 <br /> C3 TATrOQM�P ©PaoclSFA P L."MUst ApPtx- n(m Sri <br /> to VEmcALWAaTFFAcr`nT ❑07AMrrtEMESr�" <br /> VVML AND W=PEF a l ARE.AYAMAMS FCR ReYWW- x0"QAT-F +!=Kt b:49 Nva EktxttDR1C tEQC1DfT5.. <br /> 4. Ust up to ten addresses In the sRace above. Select the,types)of fates from the list AbovO by checking the <br /> appropriate box(n). At Ieast one file type MUST be solected- :ax�"S 46Q-0938 or m��_�e addross <br /> indicated _ <br /> above. Address ranges Wai not be accepted—for addltlor+al asslstanct with WE addresses,contact <br /> ti-�o EF{D.Appidcation�received of#er�:t10 pti��af+II be p er" the next business day. <br /> 2. The EHb will notify the Applicant if any ERD flies cxlst. An appointment for review will be corfirned <br /> mpproxfnutely ten(90)days after N0010 of W110ation. The files vriU be held for a mazlmum of five business <br /> days for rev(m. Appointreients should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by END staff imay not be IrtunQdlatalt available for review. A new <br /> application may bo submitted when the file Fs available. EH[)staff at the expense of the <br /> r4. Any file not retarned In the same condiuon is reieasod wal be reorganized by <br /> ,cant, Future file review, b the save a plicant may Muir©a$93-GO depositptior to revieWf. <br /> apPl y p - <br /> p <br /> N rte" ti 'ti y <br /> 040 042-006 <br /> �sl2vca , <br />