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14 13:06 FAX 310815 =^4 Z001/001 <br /> INS SAN JOAQUIN COUNTY <br /> E. E L ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazeltorl Avenue, Stockton, CA 95205-6232 4 <br /> AFR Walephone. (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd If eo�4 <br /> 77 <br /> '��t-,,_HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT' BUSiNESSIAGENCY: <br /> PHONE (1): PHONE(2): F ACSIMILE: <br /> lease allow 10 businets days from d&A of application submittal-*ranLRt1ve only-must be coinfirm&d) <br /> CHEC XTO EXPEOITE RLQUEST-$125 FEE(CASH OR�CCOECK ONLY)-REQUEST PROCESSED IN 3 EQSIN SDAYS <br /> SIGNATURE 0 APPLICANTL����� DATE q Ip P <br /> FILE ADDRESS EHD USE ONLY <br /> Strant Street Name C;ty <br /> El Unit 1 <br /> I Z5 <br /> 2. <br /> 4. unit 3 <br /> 6. <br /> 6. <br /> 7. <br /> El'unit 6, <br /> Spodfic Date Ran e Df Information Requeated" From to <br /> 01,UNDERGROUND ((UST)CLEANUP SITE(LOP) 0 MEDICAL WAsm FACIL17Y TS1,90LID WASTE FACiuTyNEHmE 2.1 <br /> UNDERGROUND! ((MONITOMNGIREMOVAL) U]FOOD FAarry MDAIRY N <br /> RT=,= E ACILnY [_]POOLISPA [j LAND USE APFUCAT10N 87H <br /> TATTODIBDDY P� RciNG �ZCONPLAINTIRESPONSE FZECCM�S OTHER(PLE"E SP�CLFY) <br /> roprIate <br /> 0.. dressU in the spara above. Salect the type(5)of files from the IM above by cheuklng the app <br /> box(es). At�& t one file type MUST be-selected. Fax to(20a).464-0138 or m?il to the,addr"3 indlq5tud-above, Addrs,-u <br /> ranges.vdii n t )a accept*d-for additional assistanca with f1le addresses,contact the EHD. Applications received after <br /> 3:00 prn will ia processed the next busiriess day. <br /> 1 --—- '– <br />