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_ .� I -'_'l1J i . <br /> IJ IJ L_11' �Y�1 <br /> `2-IL:JU11•.J i"J_I �: rVll'll('7: �L�JI Ili'-. .�1,�1 L:J'-; ILLU I - <br /> 03-1$-24 0 10:25P41 To 159 s7f 2s P.t7: <br /> P+SY r�ECEC V _� ErsD La'IS11MGCR <br /> SERVICES <br /> SAN JOAQUIN COLINTYP>at3LIC HEALTH <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 3*4 EAST WESER AVENUE,THIRD FLOOR <br /> Au ZOoo ST(209}}CKTON CA �2 <br /> st1-3420 <br /> ENS HA ANDA PUBLIC RECORDS RELEASE APPLICATION <br /> P� I'PLICANT -" IItJ5WC53fAGENCY <br /> ADORESS <br /> I HONE :SJR 7 b F16 2,1 FAC3WILE CA 4 �1 •� 4 <br /> i TIMES m <br /> TENTATTYi_"APPOINTMENT DATE AV <br /> (Mosso give 7 to 10 buai S days Iran date of Rpplieaum suhmitial) <br /> t� CHECK BOXTO EXPEbi7E REQUEST-U7.60 PEE-REQUEST PRGCZSGED IN 3 ELUSiNESS DAYS <br /> SIGNAT�IRE OF APPU(;ANT, DATE <br /> FILE ADQRE>aS THS$SJUE fiND STAFF USE ONLY <br /> ro Ktr°• pROGRAM ELEMENTS SEARCH <br /> f7 5 3k o S - b <br /> ��`3�,�S' Uoa. �� t . • 4 o b� 2 `Sl ?�tSC <br /> TC ST <br /> Y LAt *a <br /> Z <br /> QQ b S <br /> ;122t 5. i 'l 0 <br /> cl <br /> 7-1 <br /> 3 7 ID �Cc % _l `�SSC I 'T <br /> ENVIRONMENTAL HEAI.TH DPASION FILES <br /> ❑ SOLIDWASTE.FACn.rrY <br /> UrcDERGROUND TANIt(USF)CI-EAhUP SITE(LOP) =1 HOUSING/i8.1tEbENT C3 SOLID WA=VEHICIP- <br /> 0THE7t CLEANUP SITE(NOH-LOp) Cl FOOD FACUW <br /> UNDERGROUND TANK(hlQt+liTOR1FiGIRE'AAOYAL? II DOG KENNEL 0 DAIRY <br /> 1�AZARDGUS WASTE GENERATOR Q CtACKEN RANCH Q PKG TREATMENT PLANT <br /> P TIERED PERMITTEDFACILITf M odaTELMOTEL G PUMPER TRUCK/YANfuCHEMTOQJFrt1 <br /> P TATTOWBODY PEIRCING D PUOUSPA ❑ LAND USE APPL)CATION$1TES <br /> 0 MI DICAL WASTE FACILITY O PUBLIC WATER SYSTEM 1;1 OTHER(PLEA3E SPMFY ABOVE) <br /> ! typ sof fll from the list above Checking <br /> 1. List up to ten addresses in the space above. SeIRCt thQ OW by <br /> the appropriate box(es)- At least one file type MUST be selected. EA to QCA)464-0138 or mall to the <br /> address Indicated al?QvC_ <br /> 2, EHD will notby the applicant it any EHD files exist. An appointment for review Will be confirTT►ed <br /> approximately fibre business days but no later than tan(10)days after rsccipt of applleatlart. The fifes <br /> I will be held for a maximum of five business days for review. Appointmcn%should be scheduled <br /> accordingly. <br /> A Fite that is actively being worked on by EHD I<taff may net be immediately available for review. Anew <br /> application may be submitted when the file is avallabla. <br /> Any file not returned In the same condition as mlvased will be reorgartixad by I:HD stuff at the experlas <br /> of the applicant_ Futuro file rovietiw3$by they"me applicant may require a$67.00 deposit prior to ravigw, <br /> "TENTATIVE appointment dates must be confirmed with EHO staff. <br /> Applications rweived after 3;00 pm will be procaasQd the next business day. <br /> i <br /> i <br /> 1CONFIRMED APPOINTMENT DATE TIME <br /> �ATE CORFIRME0 PHONE FAX INITIALS <br /> F <br /> RE1fiE111lED YES NO REVIEW DATE <br /> GQ 14 WVR� <br /> TOTAL P,01 <br />