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-- �, � ."r .� <. - <br /> 10/19/2004 16:14 FAX 643904 r i1 Qui 8 <br /> SAN JoAQUIN COUNTY <br /> ENVIRONMENTAL HEA�.TH DEPARTMEitT <br /> 304 E Weber Ave P Floor Sfocldofl,.CA 95205 <br /> - <br /> 9 209)468-3420 Fax: (209)46"138 Web:www.co.san joaqui�q.ca.us/chd _ <br /> PUBLIC RECORDS <br /> hREILEASE APPLiCA"T10N <br /> �h[!+k" ' ` A li 6-el <br /> APPLICANT: BUSMEMAGEIVCY: <br /> ADDRESS: [L <br /> PHONE: <br /> 001 �bl'3�13 FAcsIMELE <br /> � - —" <br /> TENTATIVE`APPOINTMENT DATE. uoy <br /> allow 10 bualttess days from data of applira "sebmltfal) <br /> CHE <br /> CK BOX TO EICPEUITE REQUEST-393.00 M—REQUEST PROCESSED IN 3 SUSIbIESS DAYS <br /> DATE L01 <br /> I <br /> SIGNATURE OF APPLICANT pr>ment Uea only <br /> UNrr <br /> FILE ADDRESS <br /> •� G Unit 1 <br /> 5 <br /> saesIto or - _ Ia ? :'f' Unit <br /> 3. Siw. Irn 4. MfOd 4(}1� <br /> ORO,-Unit 3 <br /> i <br /> e- MOM Unit 4 <br /> 7- a� <br /> B. sMf/ [ �,✓1 p Unit S <br /> e- S,fei <br /> Aid f "- Y <br /> d6 �G"i�� • 41DEPARTMENT FILES I <br /> �. � <br /> y� © SOH WASTE FACILITY <br /> L-i : i :4TEMENT <br /> �- j� .. Cl SOUD WASTE VMCLE <br /> U13 U"xI HEERR Cy q 3a ....� © I rY In DAIRY <br /> O PKe TWAT�T FLNT <br /> fes H Pi PF� TRtCKIYARDIGH <br /> EMTOFrS rn� <br /> i 0 LMD USE AMUCATMN STYES <br /> In TATTWIS SEs <br /> 0 MEDICALV <br /> ct the"*s)of tiles from the list above by checking <br /> 1. Lii. er , br <br /> 5T be selected. F a 209 464-fi133armailtothe <br /> An appointment for review willbecnnl9rrned <br /> 2- E n ten(10)days after receipt of awhcaiion. The files <br /> ai review. Appa;ntmen%should be scheduled <br /> wL <br /> accordingly. ma not be Immediately available for review. A new <br /> 3. A file that Is actively being worked on by;,EHD staff Y <br /> application may be submitted when the file Is avaiiable. <br /> 4. Any file not returned In the same condition as released will be.reorganized <br /> d by EHD staff <br /> deposit t the t expense <br /> the uppik ant. Future file reviews by the same applicant may I <br /> 5. *TENTATIVE appointment dates musk be confirmed with.EHO staff- <br /> wiii'he processed the next bush �•, <br /> 6. Applications received after 3:00 pm . <br /> EONFIORM <br /> ED APPOINTMENT DATE TIME <br /> NFIRMEDPHQI�EFAXINITIALSD YES NO REVIEW DATE <br /> MrAM <br /> i <br />