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TO { 1 1316a645633 P.01 _ <br /> p � -�d01 11:d8ahi FRQ <br /> SAN JOAQUIN COUNTYPUBL1C HEALTH SERWIGES <br /> .I ENVIRONMENTAL HEALTH# <br /> OlvtslOi <br /> 404 CAST WEBER AVENUE,THIRD FLOOR U U <br /> i STOCKTON CA 85202 <br /> (M)46&3424 <br /> PPSLIC RECORDS RELEASE APPLICATION <br /> r1P?a.ICANT4t—_.rS hE iY _ p'�$SNE$S1AGE3dCY_ �� �S - — <br /> ADDRUS <br /> FHONLI(62 jig a YI x aVACSIMILE 3-- — - <br /> I <br /> TENTATIVE'APPOINTMENT DAriQ b TIME !3:.o t�_ — <br /> ttPteasa giv4 7 1x79 h Inept daYts Tram dace olopplicatsosi sUbmltxail <br /> Cti�CFC BOX TO EiFr;OFTE REQUEST-3FJ7.W FFi-REtt7EST PROCrZSPD iN 3 HU51PfE5S DAYS <br /> SIGNATURE OF APPLICANT DATE f <br /> FtL ADDRCSS THl9 SIDE F-HO STAFFUSe ONLY <br /> PRQGRAM ELEMENTS SEARCH <br /> 1 <br /> C tJ,4 t i <br /> i <br /> F <br /> I ENVIE 0Nh(l~NTAL HEALTH DIVISION FILES <br /> E } , <br /> __..... L11iD�'A_rIK{U�CLFAIYVFSR�k, LC C1,fiQ1S5WGRSA7�AiENT=-t ..:�"El SaLlDYYAEi�-PAGIAIT'f''--. --"'-"-=..�'�.,"- ,-•,---:-�-, _ <br /> •11N0E�#ROuI'ra TAf11�QAOHIIC}RINGfR�MOVAL} � DOG i(t'N:J�t. � OAJRY <br /> CJ HAZARn0e1$VYA+T�GENEFWTUFI � GlilCitE�1 RANCH � PKG TRf;Al7NENF PL.A1iT <br /> t7 'rlER>EP PCRMrr=Eu FAClLY1 Y R MC7TpL7NOTt;i Cl Plt[APFFLTRUCKtYA 1GHE11t TOV;STS <br /> 4 Tf1Tf00160oY PEiRptyp I] PO4USPA "` R LJ4NP V3EAILJCAYI41d$tfES <br /> � ME4ICALWASTEFACIUTY 'C7 AU$i1CWATEfiSYS'rF.M a DYFiEfz[Ft.I,JLfiESpEC1FYAo0Y1±y <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the 11st abdVo by checking <br /> the appropriate laoz(e5). At least one Elle typo MtlST tae se3lected. fjx to209 464 o <br /> address I,agipafed jbove. <br /> 2. EHD wilt notify the appllcant if any EHD fifes exist, An appoInlment far revlow will be confirmed <br />{ approxlmataly five business days but no later than ten(10)days after racelpt of application.-The files <br /> I velli be held for a maxjmum of fire business days for review. Appointments should be sehadulad <br /> accordingly. <br /> �- A tllo that is actively beim worked on by EHD staff may not be fmmucilately available for raviaw. A new <br /> application may by*ubmitted when the file Is available, <br /> 4. Any fila not rotumed In the same condition as released will be reorganized by EHO staff at the expense <br /> of the applicant, FgtUra file revlews by the Sarre applicant may requite a$87.00 deposit prior to review. <br /> 5. *'TENTATrVE appoir tment dates must be conflrmaci with EHD staff, <br /> 5. Applications rec-Cvad after 3:00 pm will be processed the next business day. <br /> 4 <br /> CQNFIRWD AP''F0tNTMEkT DATA~ TIME ' <br /> DATIr CONFIRMED PHONE FAX IMiTIALS <br /> f REVIEWED YES No Rl;YI"DATE <br /> .DP t� ua.nrl00 l <br /> TOTPL P.01 <br />