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11/22/2005 14:22 916-786-a'�66 LFR PAGE 01/01 <br /> 46401: EWIRONfvENTAL H --PAGE 02 <br /> �J <br /> SAN JOAQMN COUM <br /> 2 2005 ENVIRONMNTAL HEALTH DEPARTMENT <br /> 304 East Webcr Avenue,3'Floor,Stockton,CA 95202-2708 <br /> ENVIRNN,I,;EN1 HEALTTelephonc:(209)448-3420 Fax.(209)464-0138 Web:www.s gov.org/ehd q7 <br /> PERIIV)IT/SE,RVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPM—W: �'cn L—�v� J eusSNEssrAQl=NClr: L� �U ✓�z ic,t�l�, <br /> ADDRESS: � �ly_ct 2cG <br /> pti*of�(t k 9[(o '810-�0 S 2- (2): <br /> TEWATtYE'pppoIHTMENT DATF. t l-.3c7- 2-oo S Tkne <br /> (Pleas*Oow 10 vastness days from date of appr+cafron sucmItW-'Teat*Uve only.must be c oarM4 <br /> © CHECK COX TO EXPEDITE FFQM.ST-$93.00 FEE(CAtH OR CHECK 0M.Y)-FtEctu=T P ROCCESs®M 3 BUSVfEs5 DAYS <br /> IGNATURE OF APPLICANT DATE <br /> usttT DtSTFif�1J CfON Q Unit S O Unit 2 . 0 UnN a M tk*4 O UnU 9 O UnK 9 ❑ Odd(deco 0d0VsEshn�ps} <br /> FILE ADDRESS EKD USE ONLY <br /> 5d1Eat Stfttt NMI# <br /> (A V1 Ot. <br /> 3. <br /> d. • <br /> 7. <br /> S. _ <br /> 9. <br /> 10. <br /> .Specic Dat Ranee cf Information Rvd: <br /> egsteFrom Froto <br /> fi <br /> UMIRONMENTAL HEALTH MPARTMENT FILES <br /> Cixmw Srm(U)M O Hodes A:sar MEET n sOt t�was�FAcusYNE E <br /> ltsttcacrdo TAxdc(UST) Q Fvoc FAcd1sY M YYASt TIRE <br /> ❑OTHER GIEANUP$rTt(HON4.OPi 0 OoG Kms. t7 DNKY <br /> WFt TAW( ��� d � -;I sT�wATM TF%AT J r P1 R <br /> ARDO1 5 WAM GCHWATM d3 pt 7wuCK1Y y Told�rs <br /> O TARED pt tRfllf�F11G7d-rrY ❑pd)Oc1SPA D l ue use Atwd=MON Sires <br /> O TATTOOMOVY P1sid�o ❑Otest(P XAn <br /> M 1Renfcu WAsra FAtxt trY HOLMArs.-- <br /> VY�l.1-111 SEPYf(:FST Fi£C�ftDS A�AYA2CA8C£F�[t Fi�Y9�N(- KOtiDAY�FRtJ7A`l � <br /> s of fdn from the list above by ctbhe dag the <br /> 1. List up to tea addresses In the space above. Sekat tlt�type( ) <br /> apL P box(es)- At toast one f110 tyke MOST be selectedt ax tow to 04-0138 d5r mail to the address <br /> indicated Above. Address ranges will not be accepted-^foradditional assistance YYIEh file addresses,d:oIltACt <br /> the EHD.Appticatlons received after 3.00 pm will be processed the next business day.' <br /> 2 The EHE)win notify the applicant If any EHD files exh L An appointment for rQview will be confirrrued <br /> app�ximatety ten(10)days after irecetpt of apocation. The fiid s will be held for a ma�mum of five business <br /> days for review. APPaintrhents should be scheduled accordingly, <br /> S. A fide that is actively being worked"by t_liD staff may not be Immediately available for review. A new <br /> applioation may be submitted when the file is avallable. F�li)sfaff ftte expense of the <br /> 4. Any file not retumd Irl the same oonQitlodn as released will be <br /> a reorganizedeceitpHor to rd viiew- . <br /> applicant, Future file reviews by the same aWl"'cant rrtaX req <br /> w <br /> Etd1><eaz-0as <br /> t <br /> sla=4 <br />