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� sxo�.aaMwwc <br /> —'"' l _) 1�`_E� u AQUIN COUNTYPUBUd HEALTHS�!�CES <br /> ENVIRONMENTAL.HF,ALTH OMSIO� <br /> APR 0 7 2003 S u4 mv aciRCTON CA OU0�FLOORa3 <br /> (209)W-3420 <br /> ENVIRONMENT IRLMUC RECORDS RELEASE APPLICATION <br /> ZKXADMM= <br /> ANT '` ewj=twAmcy VA5 lvrp mi,;g <br /> Edna <br /> TEN1'AWL-APPOlNtNWDAM Af Shen ef_t oolil1TatE .rte r:A,c �cS Gr�t�Krrf 5 <br /> (Pian.give T to 40 buWnws tram date of appal"don submtttat) fRw�'v✓ 'j z4m / <br /> CH"K a=TO E]CP MM REQUE8T 489.00 FIN-MQUOT PROCE53ED IN I BUSNLU LAYS � <br /> jrSIGNATURIE OF APPUCANT AA <br /> FILE ADD)mss PRWRAU G e" <br /> . N <br /> 1 w <br /> ENVIRONMENTAL HEALTH DMBIW FILXS <br /> d UNDO 7ANK Mn=ANUP suit(LOP) a HOt1StN6 Aa11T1JiAaNT Cl SONO WASTR FACILITY <br /> t7 0-nm CLEWW WM POWLOM O FOOD FACILITY 0 OOUD WAM VEMICLE <br /> O uwootsmoWio t"K A1oNffcmDiQlmaoVAL) d WO KAWBU <br /> ODA <br /> t7 HAZAROWwmE TOR Cl CHICK RANCH pxr.TNA7AET PLANT <br /> dd10tMTEPACU" 13AOTlL11dT:L R TR1CXt <br /> WTOtk" <br /> G LANG U$9 APPLICATION S"S <br /> (7 TA,1TOOMMY PORCH t] 110010811Ap 0MR rjAER 4KCFY A1lCNE) <br /> G MEDICAL.WAFT FACS O <br /> 1. Lhd up to Un <br /> addres"s in tits spam above. "Set the type(&)of files from the list above by checking <br /> tha apprapda*byes), At least one file type 1r UW be solect0d. IF " o(2G@l X138 or mats t%rhQ <br /> 2 g iy Ithe applicant H any EMD tiles oxlat. An appointm*nt for review wPA be aonfirtned <br /> approximatety five business days but no later than ten(10)days after receipt Of aPpgoatlon- The files <br /> will be held for a n Xknurtr of five business days for nwiow. AppointrneMs should be scheduled <br /> accordinglylater available for review. A new <br /> 3, A Me that is*C"w <br /> taelnp worked on by BHb staff rnsy not be iiitrrted Y <br /> applleaEion may be submitted when the file is Available. stale at the expense <br /> 4. Any filo not returned in the Sarna condition as rolaased wit!be reorgan(ted by t or to review. <br /> of the appikent. Future tib rovWws by the same applicant tray require a$89.00 deposit prior <br /> 5.8. �,a'T�sons eed aftar j- <br /> IL pm will ba prtment data*must b* ocessed the buainoea day. <br /> 7C0NF:(FtMF.D wpP01NTNEtxT'RATE: T1AllE <br /> DATE CON wj!ED <br /> PHONE FAX INITIALS <br /> ' ypEp 1l&S NO RGVIEIH DATE <br /> Ed WU60:OT CM L0 .1dd 'ON XU4 WOW <br />