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SENT BY: ?F.0�001 415 507 7880; JUN-11 -05 ,I <br /> 38 ENVIRONMENTAL HEALTH' <br /> DATE R=fJVMPgC,E 0I. <br /> JUN 1 1 2003 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> "MIR.oN[VIFNI HEAD L, 304 EAST WESER AVENUE,THIRD FLOOR. <br /> 'f,,JJT/, FR1'ICTS <br /> STOCKTCN CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT _13USINF.4"JAGENGY <br /> ADDRESS _, 5 LE- IYC 0 , r7,AIV 1)?-AN C-I,'- ('0. <br /> PHONE FACSIMILE <br /> TENTATIVE'APPOW"AENT DATE 71ME <br /> _- <br /> (Please give 7 to 10 busirms day!:from dl8Km of applicifflon sibbinItIfl) '002 <br /> CHECK BOX TO EXPEDITE REQUEST•/$$89,00 FFRE-RSQt1EST I IROCE"EID IN 3 BUSINESS DAY ii <br /> I <br /> -SIGNATURE OF APPLICANT DATE C5; - 17, <br /> TV <br /> NrSSIDETEFTX-TUSECINLY <br /> FILE ADDRESS PROGRAM ELF-MV-1 ITS,,$I', 11 <br /> C/F FV/V <br /> Lor IV r- i e;,rb tie-tV ri <br /> ON L.9 5TF-r=,15Tro e-r-ro/ <br /> v�V5 <br /> -15 <br /> N. wjl,�,OAJ W r. qT0, <br /> (0 <br /> N- 1011,yUN 1y ENVIRONMENTAL HI�ALTH 101A FIL <br /> 4% UNDIERGROUND TANK(UST)CLAJANIJP SITE(LOP) 0 HOIJSINV AEIATI!M1iNT y <br /> Ur OTHER CLEANUP SITE(NON-1,01P) 0 FOOD FA.-ILITY 0 30LID WASTIe VEII u! <br /> t5(UNrjaRGRouNo TANK(MONITORINWREMMAL) 0 DOG KENNEL DAJRv' <br /> Pq HAZARDOUS WASTE GENIJRATOR fZ CHICKEN RANCH PKG rRI=.ATM"-NT PLANT <br /> 12�TIERED PEAmrrrED FACILFrY 13 MO'MLIH crml, 5t PUMPEF:TRU�-Kn'ARDICHOMTOILLTS <br /> M TATTOOMODY PEI.RCING 0 POOWSP k Ig LAND U2E AP PLICATION 3"S <br /> PK MEDICAL WASTE INACILITY 0 OTHER(PLEASE <br /> I U!kt up to ton addresses in the space above. 4;elort tho type(s)Of files from the lisit abuye lilf cliecking <br /> the appropriate box(es). At least one file type MUST be selected. or mail to thn <br /> address indicated above. I <br /> 2. EHD will notify the applicant if any EH0 files a-dat, An appointmOnt for rsrviow v,ill DO':*nfi iNJ <br /> .pplicatio Tho flies <br /> approximately five business days but no later than ten(10)days after reC')Iikt Of IPPlic2tio <br /> sch uloo <br /> will be hold for a maximum of five business dp-yS for review. Appoirtmarl-1:8 91101 Ild be 1`1 <br /> accordingly. I. <br /> 3. A file that Jr.actively being worked on by EMD staff may not be immedtatvly oym-1 table for ra-iew. A now <br /> application may be submitted when the file Is ivallable. <br /> 4. Any file not returned in the same condition as released will be raorganizcd by EHID suff at 0expense <br /> of the applicant. Future file reviews by the wine appll*aAt May require a:$49.0 de;101ERPI�hrb3 reviOw. <br /> r4 <br /> 5. 'TENTATIVE appointment dater.must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business lay. <br /> iarg:J�). <br /> ir Fax Note P37—1-4 <br /> P, <br /> CONFIRMED APPOINTMENT(}ATE <br /> ATE .;rfn ITo ll ll <br /> DATE CONFIRMED P1,10N <br /> :haw <br /> REVIEWED YES NO <br /> !0H <br /> END <br />