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44 <br /> s <br /> 1 <br /> '-:ue.•r�xEt;enev efwicx:HuLbr]t ��6-`�J� <br /> SAN JOAQUIN COUNTYPURLIG HEALTH SERVICEs <br /> ENVIRONMENT-AL.HEALTH DNISiON <br /> 304 EAST WE13ER AVT_Ntf!•,T3itF.D FLOOR C � vj <br /> ST"KTON CA 9SW2 so ���dJ, <br /> (203)468-342PU C' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLCANT t t '� f v SUSINESa'AGENCY ^ 1 <br /> ADDRESS L� `� pQQt1-� `-A �{ O <br /> FMOKH ~�Q�" FAGSL�I:LE S'se-- <br /> - <br /> S! <br /> TFNTATIVH'APPaN'TMENTPATS 1� ��" TMF- <br /> (Pinexs..gteo 7 to 10 a:alnnae days tram dato of appIkatton aul;Mittat) <br /> CHECKS=TO WC --DfCE E&-RE MOM=IN 3 ZU-M YS <br /> $[GNATURE CF APPLICANT DATE _A')Af/+ > <br /> FILE AM)RESS TMtS 1902 EHD STAFF USE ONLY <br /> PA00RAFAELEMEM 6FARCH <br /> 4 <br /> ��•'.O I <br /> ENVIRONMENTAL HEALTH DIVISION FU.ES <br /> t^ UN0 RGRQJhD TANK(U$:)GLEA Yt1�31 M(LOP) HOLL47?t'3 ABATEMENT SOC1DNiA$TE FACILITY <br /> d1irA CLEANUP SITE tNCK4-GA) 0 FOOD FACILITY Cl 50tID WAMVEHICLZ <br /> GwT <br /> 1j=1; :ANK(14ONITORC.tiGIRFaII0VAL) C! DOGXF-NNEL U DAIRY <br /> 0 HAZARDOUS WASn GENLRATOrR M CHICKEN RA."ieti 6 PKG TREATW=-NT PLANT <br /> D TIERED PEE>UITI-ED FACIL I Y Cl MOMMOTEL 0 PUNIFER TKUMYARDICHEM TOILECS <br /> Iv TATTOO,BDO`!Pitir.CINU a POOL5FA m LkND USE APPUCATION SrrM <br /> 0 t4EDICAL WASTE FALL.M fn PLMLIC MATER SYSTEM ! OTHER(PLEASE SPECWY APOVE) <br /> 4. List LLQ to ten eddrea9Ca in the spate above. Select the types;of(Iles from tt12 flet about:by Ch@cKl 2A <br /> the appmprlate oox;es). A:Ieast one f;ie type MUST be Selected. Fax tp(949)-40-012.4 or mai)to the <br /> AddreXE Int(=Zg„a <br /> 2. EHD Will notify the applicant if Tiny EHD frlpe oxist. An appointment far review will be confirm8d <br /> approximateiy tlVC OUWnesS clays but no later than ten(9 0)days after receipt of application. The files <br /> will be held for a maxftnum of five b"inolx days for review. Appointments should b-C schttduled <br /> accordingly. <br /> 3. A file that is ac Vvely being worked on by EHD staff may not be inunediately available for review- A new <br /> application may 6e aabmitted when the file is available. <br /> 4. Any file not retumod in the varve condition ua released will be reorganized by EH0 staff at tree expense <br /> of the applicant. Future fila reviews by tha Blame appticant may require a$7$.00 deposit prior to review. <br /> 5 (TENTATIVE sppointm Kt Slate:must be confirmed with EHO staff, <br /> 6 Applica sons mcelved atter 3:00 prn will be processcd the next bvaincsa day. <br /> I CONFIRMED APM"AtEN7 DATE TIDE <br /> DATE CON=IRMED PRIONS FAX INITIALS <br /> P:EVIMED YES NO RE'\1JEW DATE <br /> rh N 14 gVIV7i <br /> .d :Jdt c:SO 0©Oc �(� 'fop 2886 828 600 'LN 3NQHd s t sR j v-*j oaaZ punoacd 140ti� <br />