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za • d ,alai e,mww w.�an jr <br /> e rrrtrceveu SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ij <br /> ENVIRONMENTAL HEALTH DIVISION j 3 <br /> 304 EAST WEBER AVENUE. THIRD FLOOR ,JUN � <br /> STOCKTI CA 95302 <br /> (200) 468-3420 ) ,l <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> _ . �; cv,. Cct� h M. ''^— UAI5INESStAGENCY � � ✓= '�'n c . W.M <br /> APPLICAur .1 __ //,, <br /> ADOHE55 r � fa s , r, ri Af.� III to c <br /> PN9HE 7.097 •� 4 $ - N (} FACSIMILE -dY� ' Y_ L .rl �•-- - <br /> r? I () M <br /> TENTATIVE' APPITMENT DATE J t-I TSE <br /> ` (Piaau Giva r (6 it burin days imms�dale oI appitmlinn submittal) <br /> CHECK BDX TO EXPEDITE REQU EST - f78.cOF8E - RE TP GESSeD 17t1 UOSWF.91q DAYS <br /> once ITc{ R & 3 i <br /> SIGNATURE,PF APPLICANTI all 11 1 <br /> FILE ADDRESS. <br /> �• Aad tJ >Jn � r� U 35� rrw <br /> Ile <br /> S VL a. r. .v1- <br /> F. 'a <br /> Cicn nrs T <br /> V ; j1U <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Xi UNDERGROUND TANK JUST) CLEANUP <br /> OP) 51711D HOUSING ASATEMEII7 bt SOLID WASTE FACILITY <br /> S (LOP) l7 FOODFACILITY rT SDLIOWASTEVERICLE <br /> IL OTHER CLEANUP SITE (NON-LOP) III DOG KENNEL. M DAIRY <br /> J& UNDERGROUND TANK (FIONITORINGMEMOVAL) O CHICKEN EL. 0 pKG TREATMENT PLANT <br /> PS HAZARDOUS WAVE GENERATOR 0 CHICKEN RANTEL 0 PUMPER TNUGKPrARDtCHENl TOILETS <br /> 13 TIEHEA PERMITTF•UFACRITT ❑ MOTELIPA O LAND usr APPLICATION RITES <br /> ❑ TATjcAL WAS TEF C FACILITY <br /> ❑ PUBLIC WATER SYSTEM O OTHER (PLHASE SPECIFY ASOVEI <br /> I a MEDICAL WASTE FACIWTY <br /> 1 . List Up to ten addresses In the space above. select the lype(s) of files g <br /> from the list above by checkin <br /> the approJlriate box(es). At least one file type MUST be selectedFa <br /> . x t 12091 4G4d138 ar majl to <br /> a res indicated above <br /> 3. EMB will notify the applicant it any EHD files exi9L An appointment for review will he confirmed <br /> approximately five business days but no later than ten (10) days after rat¢ipt of application. The Files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accardingly. <br /> 3. A Tile that is a4tivclY being worked on by END staff may not be immodialeiy available for review. Anew <br /> Application may be submitted when the file is available_ <br /> me Condition 86 raleascd will be reorganized by EHD staff at the expense <br /> 4, Any Tila not returned in the sa <br /> Df the appecant. Future file reviews by the same applicant may require a S70.00 dep esit prior to rev7ew. <br /> b. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6� Applications received after 5:00 PM will be processed the next business day, <br /> C <br /> e "C�N } $ P� f�S9 <br /> 5 NQ w!TWITZFVW p f � uY •r REyi_ ._. _A . . • • + . •• . . . <br /> nzm "L l Wd9v ! ZZ 6561-1A-ZI <br /> co-Td c't32CG'bl3 0.1 <br />