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sem- <br />` _ .... - No, 2533 P. 5 <br /> Elio Lac NUMMA: <br /> SAN JOAQUIN COUNTY <br /> J 1 En oNmaNTA>L HkA,Ta DRpAnnmNT <br /> O C f 0 2005304&est Weber Avenus,3`a Floor,Swekton,'CA 95202-2709 411 <br /> ToUplwnEs(204)468-3420 Fsz:(204)464-0138 Veba www,sjgov.or0hd <br /> ENViRONNENT HEALTH pUBLIC RECORDS RELEASINGAV APPLICATYQI ' . <br /> BUSINEWAGENCY:�� ks mama <br /> ADDRESS: PO, tboil coL(D <br /> o►� r•, -�1�3- � PwauE :_ 7. FACOPS.E: <br /> TENTA APPQa Tt)AM Loy If, OT <br /> (pbaso zilow fd budrmo days from data of appilbaW submittal-*Tant0he only-mut be condlrrnod) R #� <br /> M CHECK box To mmm REQUEmT-59 FEE(CASH OR CHECK ONLY)•REQUEST PROCEMO IN 8 BUSINM*DAYS � <br /> SIGNATURE OF AP?L1GAN'I' DATE <br /> UNrr DBME n0N D UFt 1 D unit2 A-VnjttjpGnjt4 Unitp D Usitti Other(ebotroa�JliBtt Rp61 <br /> FILE ADDRESS E IRD USE ONLY <br /> Sorestt etre t.N ma e' <br /> 1 Q7 K4SAW VID <br /> 2 ill, <br /> p— m- <br /> Spscft <br /> . <br /> trate Range of Womation R-}+Asted:Krum 1 to <br /> FtmRowmrr.NTAL 14F-AL.T1i D!_PAR'L"wfENT FIL1=1 <br /> 014oum m¢Ae TmE-T D SOLW WAMEFAcamAtEHICLE i <br /> IUrromwvmaTauX(UST)CLEANUP Sme 1O') Cl FOODPAMIrr o WASTFT= <br /> OtrsEAL CLEAMP eM(N 401 d oos NaaHFa 0 0AIRY <br /> � (� <br /> UNOEMMMND TAM WNGWFAMAL} <br /> O WASLEWASEeTRZA'ritieERrAurr <br /> 'm HAZARACAra WASM V�OMMATOR A RAW 0 PVWtR TRucnUlfANurs <br /> clasEa To <br /> Q TOM PEAMMM FAOLM a llAoro❑D PA 11LAm USE AppyyAMN WFS <br /> 0 TA ocfton Pam 0 OTHER(PLEASE SPECIPA <br /> p 11M=ALWA=FACUrY <br /> YftL Arlo SEVM Ptawrr ROM=ARE AVAUASLE MR RMEw•>RdNOAY,FRIOAY 8:a0!w-6:40pw -���HoutrAY3 �i <br /> 9. L.lbt up to ton et,(dremN In tha apace abovL Select the types}of fLw from the Ilst above by checldtt0 tics <br /> appttlprlate 40m— <br /> box(ar3). At least ane MG tjP$1�lST be solected. Fax to( 1+[64-tt138 ar 11 to e a <br /> Ind d abM. Address rari0es wgl not be a=*Ptbd-fOr addMOn$l isMstmwe aAth fl10 addra�ses,sot ct <br /> W M.Apoicavons meived after 3.00 pnl will be preceew the next business day. <br /> 2. The RHD will notify the appllCant if any WD files exlat An appointn+ent for re~VIII be confirmed <br /> appanLCLn+g*ten(10)days after'malpt of applloation. The file$Vlp be bald for a maMmUm of five business'S <br /> days for nav(ew. APPoinbttents should be scheduled Wrcordlnfih►-. <br /> 3. A fl1s that is actively belrig worked on by EHD eaff MBY not be Imtttedlately available for review. A ne w <br /> appl[Calion may be submtod whan the figs is available. <br /> 4. Any file not returned In the same condition acs released will be reorg"tmd by EHD at tris expense of rite <br /> applicant Future file reviews by the same 8p(AVAnt may require a$83.00 depo6it Ptior t4 f9vlevd. <br /> sxn.aa.o:aaa <br /> EO/Z0 3!Jdd TL�b6EE60Z 8b 60 500Z/0Z/0t <br />