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12-07-205 3:OGPM FRCISERMAN^CAPITAL 4153451481 • P- 2 <br /> rraU wu onawocn <br /> DATE RECEUM SAN JOAQUIN Count' 2005 DEC -7 PH 3: 0.9 <br /> Eh'V>[�tONIV MWAL HEALTH DEPARTMENT 70�.�F4 1 •;T Y <br /> 304 East Wcbcf Avenue,3i4 door, Stockton, b I R ON t;E N T A L <br /> 'Pelcplsane:(209)468 3420 Fa::(209)454-013 8 Wcb:www.sjg0v.1D;*T N D E P P,T M E N T <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPMAW; B�S1tiFSSJ�GF-t1CY: <br /> AWRESS: r <br /> Cff•Y ��p"o <br /> PHONE 1,1: X15^3 %moi'd �'rEc2): I5` FRcslaaa �� " <br /> TENTATtW As~ 00nUEW MATE. TL�e• <br /> (Ftexs�muorr 14 bu�oss dors froom�of � *'�•-rer>r��7I-rauat by cot+flgnod) <br /> YS <br /> M CHZCk Box To expeuTE REQ (CASH OR CHECK pkLY) REQiI�+T I STD Ml a B► Q <br /> SIGNATURE Of APPLICANT � _�_ DATE <br /> �� ❑ lht d Yap.-F7escrtpaon <br /> FILE ADDRESS Etit)USE ONLY <br /> StnNt A &de.t ISL° C �, <br /> t. C Unit 1 p <br /> 2. O Unit 2 � <br /> 4. x2Unit 3- <br /> 60. <br /> 6. U <br /> 8, t 0 unit a <br /> C1unit 6 <br /> Specific Date Range of Information Rsquostcd: <br /> ENVIRONMENTAL HEALTH DEPARTMr;NT FILES <br /> -�MtMb TAM(UST)CtE�P Sff1"P) 0 1Ow364 60'M W�FAMn YlvE►C-E <br /> -OTHER GLCAWP sm{P wl'op) 0 FpM FAcb trr c3 WAAYe TIRt <br /> PLAW <br /> �i"gNpQR o TAtiK(ll[. AL) U Dog KENNEL ❑omky <br /> (�41A2ARDOeJg WAS GEHk AA O CHCAEXPAmr-W Q WABT£WARU TRiA 0$C WA1_ <br /> TWR,ED PLVATTM FACT M Ci 1607WHo u tO 1's R rRtlCttlYJ1ROIGMEM1G�l Tor ETS <br /> D TATTppftoY PtEkCtN6 <br /> 0 POWSPA d L om Ott ANt}QAT"$tris <br /> "COXAL WA Tt FAGLft G O"eR(FLL sr 8Pt ctrr) w_ <br /> WGti AND StpM pUOUT R%.OW=Ant AVMAMA.E"mvAlw•MONDAY.fit*AY 8.40 AM-5,00PV - FXcUorco WMAYL <br /> I. List up to ten addresses in.the spwA above. Select the tyWs)of files from the list*Wove by c�k)rrg the <br /> appropriate box(es). At least one file"MUST be selected. Fax to 1209)464.0138 or rnafl to the gess. <br /> indicated above. Address ranges win not be accepted—for addkk>nal asslstance with Ria atddress9s,contact <br /> the END.Applications recelved after 3:00 pin will be processed the nexf business day. <br /> 2. The EHb will notify the applicant,if any END files exigt. An appointment for review wltl by confirmed <br /> approximately two 00)day$after receipt of application. The flies wilt be held for a n*Xintum of five business <br /> days for review. Appointments should be scheduled a=rdingly. <br /> 3. A file that is actively being worked on by EMO staff may not be itnm*dlaWy Milable for rCvitw. A nm <br /> application may be submitted when thA fila i$available. <br /> 4. Any file not returned in the same condFtlan as released wift be reorganized by F.HD staff at the"pens*of the <br /> applicant. Future file reviews by the same applicant may require a$93.120 deposit prior to review. <br /> ono aac <br /> ,onuzoa4 <br />