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� . i'at.i4111k 1.IY 1.V t J Q Z <br /> U7/10 41 hioN iG;lA FAX 201; b21 1'f la?4Z''941e2 P.02 <br /> Z'1r'll'4 r- <br /> �.. IJ utD LrG mIiEIR <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> s., A <br /> U <br /> 304 <br /> EAST WFBER AVF-NUE,THIRD FLOOR h <br /> ` sTvl+icToN CA 95202 .�.:.... . . . ... ... ,� <br /> ESvVIftOIV� ENS HEALTH (209)468-34201 T HEAL PUBLIC RECORDS RELEASE APPLICATION <br /> BtAUNESWAGENCYAl� <br /> RIwSS wp <br /> V FAC5IMLLE <br /> TIME <br /> Tt14TATIYt APP01NTIdLNT BATE <br /> (Plta�s p;vo 7 to 10 bu.In*"daym from tWo Of applirrlloa 1&4bnxt42l} <br /> GFTECK$�[Tt3 E7CppI'fE'REri13 -SMG4 —ISE EST PROCESSED IN 313116111E6$'t7ATS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE At3VKtZ- <br /> J <br /> r 7 C <br /> ENV IRONl4 ENlTAL HEALTH OMSION FILES <br /> uNNoEPOROLINP TANK{UST}CLEANUP$3TF_ILOPI 0 IjOV31Nq ABATFiMENT )W s0uD WAeTE FAGWTY <br /> OTHER CLEANUP&ITIi(NON-LOP) FOLIO FACILITY 17 SOLID WAS7M VQMDCLJE <br /> '2auNDLRGROUND TANK(AiCHITOWNGIREMOVAL) ❑ OW KEN![EL DeVli1 <br /> HAZARDOUS WASTLZ GENERATOR 0 C"CK>:N RANCH PKG TREATMENT PLANT <br /> TIERED PCFt1AITTEI]PACILl1Y ❑ AWTELI"01-EL pumpaR TRUr_rj fARWCHF_M TOILET* <br /> G IATTOOI9ODY PIERCING C7 POOL OPA � LAND 113E RASE SPECIFppucATjobiY <br /> ABO <br /> 0 h LDjCliL WASTE FACRJTY ❑ PU13LIC WATER$YSTEhA G7 OTHER{PLEASE SFfuCIFY pBf1YL') <br /> 1- i-ist up to ton addresses in the spasfe Rt)OVQ. SelOct the typ (s)of files from the list above 13y cl,tQ tl nggg <br /> th©appropriate box(e*). At least Ona file type MUST be aelQGtQd. <br /> address Indicated a4Qy2. ad <br /> 2. CHD will notify the applicant if any EIHO riles exist. An appaintMent for raveaw will be confirm <br /> approximately five business days but no later than ten (10)stays after receipt of appilr,ztion. The files <br /> Will be held for a rnaxirnum of five business days for review. Appointments should be scheduled <br /> accardina ly. <br /> 3. A ler that is actively being worked on by EHD staff may not be immediataly available for review. A na <br /> fiw <br /> applications may be submltted when the file Jr. available. <br /> 4. Any file not re€urnra in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file previews by the samR applicant may require to $78.00 deposit prior to ravieW- 4 <br /> 5_ "TENTATIVE atppolnM% nt dates must be confirmed with EHD staff. <br /> 5. Applications received after 3*00 pm will be protesse.d the next business day, <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED FtiC)HE FAX LNITIAL.S <br /> REV 1EWED YES NO REviEW 1]A TE <br /> cn oa i. o <br /> TOTRL P.82 <br />