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To 19169529152 P.W. <br /> 1e-lraeee �:65Fli'1 ,�, <br /> SAN JOAQUIN COUNT'YPUBLIC HEALTH SER ( <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WS�E13ER ON CA AVENUF, <br /> OlRD FLOOR Q C T 12 2000 <br /> (209)46&3420 ""MINT HEA H <br /> PUBLIC RECORDS RELEASE APPLICATI6 <br /> C. <br /> a-usMEMACIENCY� �it1S )�orC1LN <br /> APFUCAN -k a, - 1Y C] L ( �nC r ` <br /> t <br /> AOORESS `-s - S — <br /> FACSIMILE_ ` Z <br /> PNON[ h <br /> fol a31 co nt1 <br /> TMENT DATE <br /> �l---•t1 (Pe give 7 to 7 D tAlslneaa day,Gom sale of-PPI <br /> llraDun slromlttsl) <br /> TENTATLVE"APPQUIhas . <br /> L.� GHECK BOX TO EXPEDITF_RFaUEST-S�EE-RE4VESTP O;E IN DAYS <br /> DATE IO la• <br /> SIGNATURE OF APPLICANT <br /> Tr115 SIDH EHb 9YAFF U5E ONLY <br /> < I plE ADORFSS TS SEARCH <br /> L�, lC 1 V <br /> ' 01 <br /> Vo '"ac`s _j_i r �I /✓1/L �cf G.U /fI' l <br /> ✓ nfe <br /> FA UC4 <br /> ENVIRONMENTAL"EALT"DIVISION FILES <br /> 1 C1 HOUSING ASATEMENr ❑ SOLID WASTE VEHICLE <br /> MCILITY <br /> R FOOD FACILITY [] SOLID WASTE VEHICLE <br /> �yar� UNDERGROUNDTANK(UHT)CLEANUP SITE iLOP) M DAIRY <br /> y� O7 RER CLEANUP SITE I�N•LAP7 p DDC KENN6L O PKIi TREATMENT PLANT <br /> �1 UNDERGROUND TANK fMGN2rON1NGIREh$QVAL) 13 CHICxEN RANCH QTS <br /> �( IIAZpROOV9 WASTE GENERAYOR ❑ MOTELIHOTEL ❑ PUMP6A TRUCKIYARWG$1 <br /> APP <br /> fl TIERED PERMITTED FACILITY ❑ pb�$PA El LAND USE EASE G'PE $1 <br /> ❑ pUOLIC WATER SYSTEM R OTHER(PLEASE 6PECIFY <br /> ❑ TATrOO760DY PEDiCING , <br /> * MEDICAL WASTE¢ACILITY <br /> ten addresses In the space above. Select the type(5?of utas from the pst above ' 1 to t <br /> king <br /> j. List up tD MUST be Selected. <br /> qte appropriats boxes}. At feast Dna fila typo <br /> - s indicalad above_ <br /> 2. aiteF receipt of application. T files <br /> EHp vr$"r ll� 1 n�Dtity the applicant iE any END filaa exist. An appQintmenl for rev{aw wlit bs evtltirtn <br /> approximately five business days but no later than ten(10)days <br /> wlll be haW for a maximum of flue business days for review, Appointments should be schequ <br /> accordin®IY• <br /> for Tw1ie . Anew <br /> 3, A tale that is acGvety being worked en by EHD staff may not be immediately avaitabie <br /> Application may be submitted wh¢n tho the is avaHabit. s1 46T revieW. <br /> 4, Any file not retumed in the samt condition as releas applicawnt may r require a S 7.00 deposit <br /> P at tilt expense <br /> the <br /> of the A-rr,r asp intmentl0 reviOWs date*must be confirm d with EHD stall. <br /> •TENTATIVE appointment Will be processed the next business day. <br /> 6. Applications received after 3;00 pm <br /> TIME <br /> CONFIRMED AP130INTMENT DATE, (NffIA1� <br /> PHONE FAX <br /> DATE CONFIRMED <br /> REVIEW DATE <br /> Ci FvlfwED YES N0 Y ai P as <br /> p i e <br />