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2004 16:14 FAX 645904 • @1001 <br /> - - - SAN JOAQUIN COUNTY <br /> ENVIRONMEN"I AL HEALTH DEPARTMENT ^ <br /> 304 E Weber Ave P Floor Stockton,CA 95205 <br /> ped 9 Z09)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquill-c3-usIchd L (J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ;PLIC IT.- �fW I, `✓` 1 B'USIfN1EvSS`IAGENCYY:�. 6 <br /> ADDRESS: Q �C�ir�l L I,,�uwt Ua 1`'�\_ 0 ( Q/y' -GI� 2k 2 <br /> PHONE: C�caol �. Ill FACSIMILE: �Q/ �� <br /> lENTATIVE`APPmTMEHT DATE: <br /> (Please allow 10 business days Lom date of applk=flon submata0 <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.00 r EE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 0 <br /> 11 Cf <br /> U U Devatrmm Uce O* <br /> FILE ADDRESS UNIT <br /> ) ❑ Unit 1 15 <br /> z sa.a 0 0r /� 0 ` <br /> x ear 'B(,2011! !!Qrn ❑ Unit f ��j <br /> 4 3A( T-KbVA+Dy� `` <br /> Z ' Efo A Al 7'o Obj Unit 3 <br /> 7. s, Unit <br /> ❑ Unit 5 <br /> , / /[ / G I DEPARTMENT FILES <br /> >dUNDERGILTEMEDT <br /> C3 SOLID wAsTF FACILITY <br /> OTH � q3c^ 0 SOLID <br /> WASTE VEMCLE <br /> ,lERG <br /> F/ <br /> ❑ DAIRY <br /> 9q1 ��J. —rh0'n ICH O PKGTREATmENT PLANT <br /> "I v� L O PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOS O LAND USE APPLICATION SITES <br /> ❑ MEDICAL I 65LSPE <br /> 1. Li ct the type(s)of files from the list above by checking <br /> th sT be selected. f�w to(209)464-0133 or mail to the <br /> a[ <br /> 2. EI An appointment for review will be confirmed <br /> aE n ten(10)days after receipt of application. The fifes <br /> wi-- 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. A new <br /> application may he submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant- Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> M04ra2ms <br /> Maw <br />