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ti <br /> JAN-21-03 10:41 Am OXOXOXOX0 55Pt--325 2297 P.01 <br /> 81J21/".0E13 08:53 454 8Ej1Tk/IF0•It4ENTAL ti TH PACE ' 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> •ut1 tQ NUMnPiA <br /> 1c_1� �� i ENY�RO <br /> in) <br /> f J o , t <br /> �., [�, NMFNYAr._ HEALTH D1trIS16N • <br /> 304 EAST WrzeE t AVENUP,THIRD FI_OOft ' <br /> JAN 2 Z�03 STOCICTON CA 85202 <br /> (209)468-3420 <br /> PUI341C RECORDS-RELEASE APPLICATION' <br /> A?iT ' '� <br /> c%S <br /> (APO,, �f ovslHESSrAceNCY _TW t.r� s.�.o .• <br /> ADURa~ 5 pc 6,:�k _ <br /> TENTATIVE'I�PPOiIVTaMCHT UnTE. ---1 �� --U Tic30 �►-� -_ <br /> (Ploaae olvp 7 in Iii huaieosz eajn from date or�ppllesiien:yubm.l(1a1) <br /> Q SHE0Ilf1XTO I x IM-IF er-ntin�cT'. 10.oa I:sa. RLQULCT n001:00rDIN 0 busilless BA115 <br /> ".SIGNATURE QF APPLICANT - - — -�t- DATE <br /> FILE APDRE55 7#4!s 51UE is o VAlro USa ONLY <br /> PkOGkAM ELEMCHTS SEARCH <br /> f. i IA t! {. r r;y, S <br /> eimc)�� <br /> S�G ,n GCtt, <br /> 3. <br /> uc fi c ..-y_t. �54Me:i��t. <br /> Stu <br /> U�?s0A-C, `IENVI ONM NTALK F.{1LT�#DNIS}(�rvc1N FILES <br /> n <br /> UNdkRGROUND LANK(OST).CLEANUP SITE(LOPI OUSING ABATC-AAFNT Q I LOUD WASTE FACILITY0LID WASTE VENICLI: <br /> : . �• <br /> OTHER CLCAOUP SITE(NON-LOP) >08D FACILITY 6 <br /> ~s <br /> UNDEFIGRQIIn DOG KEMN6L <br /> NrI TANK(Me5N1T417Ij4GjAFMOVALI DAt>�Y <br /> i� 0 CHttLN <br /> ICRANCH VPKG TnF_ArmDlT PLANY - <br /> "!!C }IAAR <br /> � DOU:.WASYE GENERATOR E3 uoTCLl110TCL C I`Lwv%tn TnV0fWAt4b10tKiA YDII.CTp;,~. <br /> TIERED PSRMITTIM FACIL" p POOIJSpA Cl L.ANo USC APt'UrATION SrMs <br /> 17 T/►YT4OlatldY P9IACINC ; OTHER(FLEASF-SvECIRY At)ovul <br /> Q MEgIGAI W/L57f�FAt:It.ITY + riShe tt5:► •..... <br /> Of f <br /> the <br /> byc . .: . j <br /> List up to len addresses In the spscq above, Select types} fifes from he sial obovC lyssftlt:1 <br /> the appropriate box(es). At toast ane rile type MUST he selected. �x 101209)404-0`138or mi 1 .,•}<� <br /> •.. eddra55 IntIicated abavl;; '•";'': <br /> 2•- EHD will notify the applicant if any>rkiD tiles exist An appofntrnent for review will be confirmed <br /> approximately five buaineSs days but no later than ten('10)daY; attar rvco#Pt of Tld be Ile c90041,110dTho f#le�., <br /> will be lield for a maxlmym of nv,e buslnosl:days for review. Appointments should be s <br /> accordingly. �i <br /> 1, Atilt Ihst 13.actively bninwhod on by E <br /> f}.vlft)stall may nal be Immedlalely avaifat�t, for rov(ew• <br /> applicmlion may bo su4lnitled when the lite is available. ` ? <br /> Ml a cams ca <br /> ndttlan as rcic>>t'cd wi11 be reor6anixed by GHD staff at IN,vApai ;... . <br /> .d_ <br /> V Any Pito not retun <br /> rned th <br /> applTcmay ay require a$69.00 dOPoait prior to rov( <br /> of the applicant: Future fila rDvlEws by lhp sam <br /> 5, `TENTATIVE appolntmont dates must be Confirmed with EHD staff. <br /> G. Appiieati*ns rccolvod after 3:00 pen will ba proecssed the next busingss day <br /> NT DATE, __�� <br /> TIME <br />� <br /> C <br /> ONFIRMED nPPoiN�'f�i>r � i, <br /> INITIALS . <br /> I YZiONE FAX, - ---- <br /> _. . . .-�..... <br /> • fV0 <br /> REVIF-W DATE <br /> z� <br /> � : YES . <br /> . l � <br />