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2 : 3 ( �QRS Environmental Svcs. 40'- 1.55-1224 p. l <br /> eceiv d e 0 :49amu+ from CCITT G3 -# PIERS E onmental page 1 <br /> -fl AM FRO] j TO 140SS360-94 P.01 <br /> w..• Gare <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICI=S <br /> ENVIRONMENTAL HEALTH I�IVISION <br /> ;` ; �_'[(.• : 344 FAST WE13r-R AVENUE,THIRD FLOOR <br /> STOCKYON CA 95202 <br /> OZ MAR —7 AM 9: (209)4611.3420�BLIC RECORDS RELEASE APPLICATION <br /> AP3'L3CA.NT� C� 1 C�✓1 O__ 13U51NE351ACCNcy C !.G ps.,. nyi*/cxi/ 1?_-;i f . <br /> ADDREss t� S. r srl p Cl'S 17-$ <br /> PHONE �'f O$ _ Z.co FACSIMILE J CQ q <br /> TENTATIVEr'PAPOINTMENT DATE AgAP TIME <br /> {Ptcz1a f, 0 7 vU�r...TC,._:;. ®IlCHECKAOXTO EXPE'DiTE RECUEsT ,. F EE N 9UStN 3 DAYS <br /> SIGNATURE OF APPLICANT � 1)ATE <br /> FILE ADDRESS THIS 330E 440 STAFF UaE QNLY <br /> PROGRAM CLEMENTS SEARCH <br /> 0 W. 1!t rr„ .2 53 rV&.1 <br /> f W_ I t X4 <br /> Soo W. 4 <br /> ENVIRONMENTAL HEALTH DIVISION FILF-S <br /> l(UNDERGROUND TANK(UST)CLrANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY t <br /> -9 OTHER CLEANUP SITE(NON-LOP) Cl FOQD FACILITY G SOL70 WASTE V4HICLE UNDERGROUND TANK TANK MIQNITORINWREMOVAL) b DOG KENNEL -O DAIRY <br /> IJAZARQOU3 WASTV OENCRATOR CHICKEN RANCH b PKG TREATMENT PLANT <br /> * TIERED PERMITTED FACILITY ❑ MOTELIXOTEL C PUMPER TRUCKfYARDICH2M TOILETS I, <br /> * TA7T0013O0Y PESRCING D P60USPA M LAND V5E APPLICATION SrTE5 <br /> 0 MFMCAL WAsTC rgCELf 3( O PUBLIC WATER SYST&A C OTHER 1PLEA1619 SPECIFY ABOVE) I <br /> 1. List up to tart addresS43 in the space above. Select the type(s) of files from the list above by checking <br /> the npproprlato tsax(cs). At least ona file type MUST be selected. Fax W 1`20.99140-Q138 or mail( the <br /> addr��,p Etzdlcat4���yu. ' <br /> 2. EHD will notify the applicant if any EHD fifes eXist. An appointment for roview will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application,-The flies <br /> will he hold for x maxlMurr;of flue bustnoss days for revlew. Appointments should-ba'scheduled.. <br /> nccor dingly. <br /> 3: A file that is actively being worked on by EHO staff may not be immediately available for roview. A new <br /> application may be submAted when the filo Is available. <br /> Q. Any flio not returned in the same condition as released will be raorganlzed by 2I-10 staff at the axpcnse <br /> of the applicant. Fut;ro file reviews by tho same applicant may require a$87.00 depoult prior to ravlow, <br /> 5. 'TENTATIVE appQintment dates roust be confirmed with EHD staff. <br /> 6. AppiicaLons reColVod after$;00 pm will be processes;the next business day. <br /> CONFIRMED APPOINTMENT DAT E -. .. _- TIME <br /> DAT F_CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW,GATE <br /> to ��r97N <br /> TQTPL P.01 <br />