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h <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES SEP 0 �. ' <br /> ENVIR6NMENTAL HEALTH DI MON z000 � <br /> Baa EAST WE SER AVE RUE TMPD FLOOR ENVIRON <br /> VOOKTON CA 0202 H <br /> �HEAtT <br /> (209}4U-4U-34MERWISER"ICES. <br /> PUSUC RECORDS RELEASE APPUCATIONADDRESS <br /> ?' <br /> ray ��� <br /> PHONE. `-�`r� F1kG&IAgLE Ua • <br /> 17.WATIVE*APPOWWENT CASE T1fItE <br /> ;rlv"9W*T t0 13 bWit Yat dale of Ra l(aatlon aubrAttao &r <br /> CHECK-9OX TO EXPEDUra MQUEST-387.Q4 ft3E-RLEWSST PROCE YS I' <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS INN <br /> PROGRAM Eti!MEWTS SEARCH � <br /> ` <br /> 41.4 <br /> ENVIRONMENTAL HEALTH DIVISION RLES ; <br /> U-409PGROU340TAkgMT)'CLF-AkVP VTE(L0P) 0 HOUSING ABATEMENT O $0tJ6WAZ- 9;rAC UTY <br /> OrXIM CLFA UP 9iT£4NOri.Lap) in.FOOD FACII.Ti'Y M SOLO 14 WE VEHICt.f . <br /> V-i+0MOROuNo TANK(MOWTO(t MOMEMOVAL) n DCO KENNEL 13 "Ay <br /> HAZARWOUS WIwTE!MFWERATQR C- CHICKE*RAXCW O FKQ TRSA•MENT PLANT <br /> TI5fe5p PERUs IM PAOUTY 0 VOTELIWOML f3 PWMPIDt•TRUCWYARDiCH9W l' LEIli <br /> Q TATTOQJ$ODY PEIRCEho Q POOLIP,A ' ' 0 'L AND Wit APPLICATM Wn. I <br /> O WFO)CAL WAST&FACii:J"I•Y Q PUBLIC WAT9KSYSTEM U QTHrdi(Pt.EAfiZ-3ftCIFY A5 Vq i <br /> 1. List up to ten addresses In the space above. -Se►IOct they type'(;)Qi iflg8 f104Tf-tlle list AA"by:-*h@;Ckig <br /> the appmpriatobox(et;. At ISASt one fW type MIUST be selected. Faz L9 f 464df'i3 <br /> as990*9Indira d Nim • . . <br /> 2. EHD will rwtWy the applicantif any EHO!lies exist. An appointment rar review will b:'oentirrnsd 1 <br /> approxilsettaiy five business flays but no tater than tan(10)clrlys Rher reiaolpt'of epp#cati6m Th4i filed <br /> will be Held for a maximum of fie bv eines days for rsvlow. Appvintments sh6uld be schedulvA i <br /> etccvr+dirsyly. - - . <br /> 3. A.ille that is actively beim worked on by E1,10 staff m7+y not be imrh*dEa3tetly available for <br /> review. IL n�1N ' <br /> aPPlication maybe submitted When the Fila is availablo. <br /> 4. Any fllit not returned In the carne ctrndition a;r*Feased•wEll tW re6rgai*4d by th&-staff at the;.sxptz�se <br /> of the Applicant. Futur1He r*V1* rs by the Sarno applicant may require s S97•.00 depo.tit it prior to retvl*: <br /> 5. *TENTATIVE appointment dates must be conf rMed with EHO staff. <br /> 6. Applicationit received after 3.00 pm will be proceseed the next business day, <br /> 4 0QNFIRMEO APPOINTMENT- _ T ._ TthAi~ <br /> j DATE CONFIRMED PHONE� FAX :)Nff AI;.S <br /> RE=VIEWED YES NO REVIEW DATA r <br /> 1 <br /> TUT/aL P'01 <br />