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°11812006 14:53 FAX 91628054P' . WKA ENV.IHUNhIf NIt1L „� ' ( 002/002 <br /> HSC19MVED JENVIROMN7AL HEALTH TMST <br /> M4 East:Wehta-r Avenue,P Floor, Stockton,CA 95202-2708 <br /> SEP 1 8 2006 T10,cphone:(209)468-3424 Fax:(204)464-0138 Web,,wv1w.sj30v.arg(cfid <br /> ENVMONMENT HEALTH pUBLI RECORDS RELEASE APPLICATION <br /> A4 fie i' z-;x <br /> PHONEr11;^9id'r372_ -ff39- FKONE(2): 716-Z75-0375 `' Fr QQSalMM.-: 2k- Z�0 5fa9. <br /> TEIq 6ATIVE*Ar°°PolrlT ENT oATE: ri r1 ra: <br /> (PIflame anow 10 turinarm daw from dale of appl 1-' a he aanfil irr�d; �_ <br /> 1r�`G}ir=GK Bflr T[3 EYP 17171 Rle €JE $99.00 E(C 1i OR �1� .y LI ; E7 t D IN 3.Efifw$td S tT4Y,�i rri�r� <br /> SIGNATURE OF APPLICANT <br /> Elr� or€ic tnf�)rination: E]LIa1❑11Aep—Description: i R <br /> Fly ;DDRESS EHD USE ONLY <br /> smot name city <br /> 3. r 3 71 0 /-92 <br /> 2. l r'1 unit z <br /> 01 <br /> 6. i 1-1 w- ate . K71;,� <br /> 16,"It <br /> 7 ! F Fes+ ES�Rl6 r� 7ze+s� 5-7 <br /> '� p/ 6 <br /> Specific Date Range Of Information Requested:From '��c- f- to. C�•@�se� <br /> ENVIRONMENTAL HEALTH DEPARTME14T FILES <br /> ucs9eRG3auMv TA4S(UST)cLEF3E11 S (ird' ) Q Solt <br /> n WAar€FAG ,zfS, <br /> LITY _M <br /> 9T0T`fFF e:�A.-1VP SFrE(NON-LOP) 13 Food FAestirr -hFte <br /> R?l:n��RGst+aJ a TA%(MGMT0i^S1ir;0M-=MC.VA'_1 C3 DOG KENNEL DAA <br /> I ,As pCt! WPB GENEHA.TGlR Q CH[CISEH RANCH " WA£1ERATER IrREAT6EMT PLANT <br /> TIERF0 PERXM71i!)laACKITY' ra MoTEaMom Rumpoz TRwKIYARDICHEm TOiLf Tr, <br /> d'TATToal13auY FERCING 0 POOLISPA C]1_awa WE ApmjcATmN STEs <br /> VirorAL WAsrE F=LrrY 13 OTHIM(PLEASE SPE CIFY) <br /> WELL AND SEPTic PeRrarr R.EcoRns ARE AvAR;.ABLE FOR Rfvm- NomoAT-FFiyAr 8:00 Am-ai.0 pm - RMILUorma HOL16Ays_ <br /> "a List up to ten addresses irr the space alp. Select the"(a)of files from tfit list above by checking The appropriate <br /> bcx asp). At MAST be 3QI&Ct8tl. Fane to#20914 .0438 or rusil?to the address Ind➢ea`ced abova. Addre:�.r: <br /> M"100s whit not.;)n accepted—for addfdonal assistance with file addresses,contart thee-EHO.Appli.atiores r€peluad after <br /> 3.91?PM will lie processed the next bu$inevs clay, <br /> Z. The EHD will notify the applicant if any EHp files exist. An appointment for review will he conFrmad approximately ton(10) <br /> days after r'ecelpt of application. The filen will be field For a maximum of five buslnass days for mlow. Appointments <br /> sh.ovid be schedulse accordirilly, <br /> _ A,Etc that is sctively baing worked on by EHD staff may not be im mediataiy ovailable for raviataf. A rICW afaul`sc€tion corny be <br /> 1-E;b-r�!torf w h9n the qI0 is%raftbly. l <br /> 4, Afiy Me nal returned in the conation as Weaned will b6 reorgantmd by kH9 staff ei$the exp nfse of ft applicent. <br /> i Faure file reviews by the some applicant may require a$25.0111deposit prior to review. <br /> 4- EHD USE ONLY <br /> H6 a@4B W�3rd446 <br />