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V1111/4VV0 11:41 rAA VZ5ZT4.11U3 BBL SAN FRAN 18.1002/002 <br /> 4640 ENVIRONMENTAL - i PAGE 01 <br /> 07/11/2006 11:35 EHJ)LOGNUMBER <br /> SAN JOAQM COUNW <br /> ENN-MONMENTAL HEALTH DEPARTivlM' <br /> f '! Ygit,D'304 East Weber Avenue, 3rd Floor,Stacktol:,CA 95202-2708 <br /> Telepbone: (209)469-3420 F= (209)464-0138 Web: W--vw.Sj90v.0r&lehd <br /> PUBLIC RECORDS RELEASE ,A,PPLII,'-'ATION <br /> APPLICA'YT: f�uay N f�S BUSRESWAGENCY: _mow <br /> ;,D'URCS'>: 2P-33 � t?`kl1j � ��SU It J"► GITYf�,g�rl��,.{a�l/l L STATE e� >s_� <br /> PHONE(1): 91-� PHONE(2.): L1."—FA.SIT LE: r i-�- <br /> TIENT1471VE'AFFQINTMENT DAM - -6 J�Ai-y 2aa6 _Thr : �`�0c) <br /> (YI( atlow 10 buelnasa d7fs tram date of application submittal-°T"entauvs only-must be catrlirrnE<) <br /> p GH;cic;6t);�To EXP9 M -t17M REQUEST-$93 CASH OR cRECK ONLY)-� MST FR'OCESsED IN 3 EVINF DAYS <br /> SIGNATURE OF APPLICANT � r--, DATE3'f [4bt <br /> Ela�nlc .—•,E <br /> Et <br /> Tdiap <br /> _ FILE ADDRESS EHD USE ONLY <br /> StaraatA� SttmtNateI <br /> W::z f , us _ O Unit <br /> 3. <br /> l <br /> .4. <br /> �I„tl1lt �, <br /> unit <br /> 9. f VO nit G <br /> Specific Qua Ranlflo of Information Requvated:From <br /> fUl"RONIVIE NAL HEALTH DEPARTMENIr FILES <br /> a^*rrm ❑HOMING ABATor�tr i Sf1t,1DV4 A.STF FA.;1Jtl'(V�iC1 E <br /> UI40E:RGRwPmTAKK(UST)cu-mou. (LOP) �IwAsTz TmE <br /> 0,ruz:R GIA u-w St (NCiN-LUP) ❑ FaoD FAaIuTY <br /> ❑Doc KumEL ❑0ntFY <br /> ITIEn-m <br /> U(aOER[vROUM`)TiF]K(fNQNC[OF'14GIRehL�JVE:I) D GH1�4 Rau�cN A:Ti={f�ATER?�i.EATr�T Pt.ArIT <br /> H,�.xooUs urASTE4[pF.RATG ❑MQ'jEL1HaTeL ❑Put41PER7 '�A?arc41Z ICeALTor r:TS <br /> PfagrrrED FA£IUTr ©P40USPA ;9�LNgD USE AFPL1r.;TIDI4 rrTEL <br /> G TA17Wr541YTP17KINn -- <br /> MEtD=LYifR-.IE FnrruTv <br /> WELL ANO Ser nc PcnBFrr F ori 3 ARE AVblr AE3Ls Fog R •lZ0iA0AY-FRroAY 8:1x1 Aen-E:00PHI <br /> 1. L_A up to tm addresses ill the tpace above. Select the types)of files ftr1 the list above by ch t qdd tfle <br /> appropriate box(es). ��t lean-it aslta file tYPQ�ft1ST b0 se9ected. Fa_x tvl?l79 "Qr01 °�'�1a R to tha addre3 <br /> ►1e addMsses,r:1,7rltac� <br /> in :ated al3gyn. Address ranga�will not be accepted-for additional asSiSUMce with f <br /> +9ic <br /> tti.E�lk7.A(�lr7�caTtions rectived after 3S:tib pm will be processed the next buslnes- day, <br /> ,', The Ehlf�AplMrAl enc at! t6°,r�appltcant if any ErHD files e)dst, An Appointment for VaVlcw will be confimad <br /> approximately ten(101,days after receipt of application, The files will be held far a rr EXITnurrt of f"Ve UaSir.�M <br /> dap.;for re-ii'. Appralntnae,rlts siouli be scTledulod accordingly. <br /> ' , d p.;fi� t1r r is a;Cti�ely lXeing worked on by EtjD staff May not be Immadiatelt'Er/ailable fa.=rcwiew. A neer <br /> epplieation inev be submitted when the file Is ava;lable. <br /> 4. Any file snot r�tuined In the sante condition as rele�ed will be reorSannzed by,E[iG staff at ttre experls;c p#tYls <br /> alaplicant. Ftltore file r0yitevr tx(the same applicant may req�jlre a$93.04 depo�it prior to re.yiew. <br /> VC 11$-04 <br /> anntraa1e <br />