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� - X001 <br /> 10 / 19 / 2004 16 ; 14 FAX 6439049 SAN JOAQUIN COUNTY . R <br /> _ ENVM0NMENTAL HEAL'T'H DEPARTMI',NT O �� <br /> 304 E Weber Ave Yd .Floor StocWn, CA 05205 <br /> OCA 1 9 2069) 468-3420 Fax: (209) 464-0138 Web: wWw.cO'San.joaqui-o,ca.us/ebLd _ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> - �\1\ 1 ; BUSWESSIAGENCY: <br /> APP (CANT: [n `vim V,""1 ` C ^ d- GI u S J <br /> ADDRESS: t L lJ 1r� <br /> c��lani _�� �, �( PI11 FACSIMILE: � Q7 � � � ^ �� ! � <br /> PHONE: n <br /> Time: <br /> TENTATIVE` APPOINTMENT DATE: <br /> l ,2� L law <br /> (please allow 10 business days tom date of appl,c�Ilnn submlttar) <br /> © CHECK 13OX TO EXPEDITE REQUEST • ;93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYSDATEI [ 7 <br /> SIGNATURE OF APPLICANT DepadmMUw Only <br /> UNIT <br /> PILE ADDRESS <br /> G Unit 1 <br /> c' <br /> p Unit2 <br /> 3. 1o11g <br /> Sal TYLOrnfov <br /> aa af ' Unit 3 <br /> Z *HD <br /> Unit4 <br /> t- sem. <br /> lid { Q Units <br /> dA : LbEPARTMENT FILES <br /> 4TEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGRI �� I vl- /n i � - rY C)❑ SOLID WASTE VEHICLE <br /> ❑ OTHER C i " , G DAIRY <br /> UNDERGaI � � O PKOTREATMENT PLANT <br /> 9HAZACi` <br /> RDOI N �OYI' L ' v LH O PUMPER TRUCKlYARMHEMTOILETS <br /> TIERM PE "I ❑ LAND USE APPLICATION SMES <br /> ❑ TATTOO/& OE SPECIFY) <br /> ❑ MEDICALV <br /> , �a '� ct the type(s) of Iles from the list above by checking <br /> 1 . Li ._ ST be Selected• o 209 464-0135 or mail to the <br /> th <br /> 96 . An appointment for review will be confirmed <br /> 2. EI n ten (10) days after receipt of application. The files <br /> a� For review. Appointments should be scheduled <br /> accordingly- <br /> 3• A file that Is actively being worked on by EHD staff may not be immediately available for review. new <br /> application may be submitted when the file is available. EHD staff at the expense <br /> 4. Any file not returned in the some condition as released will be reorganized a $3y00 deposit prior to review. <br /> of the applicant. Future file reviews by the same applicant may reel <br /> 5. "TENTATIVE appointment dates must be confirmed with .EHD staff. <br /> 0 Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> euo asmma <br /> s,armc3 <br />