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`�- 10--17-2000 1W 28W Fi') TO 1559SLT7126 P.0-) <br /> �aC wt„4WY—" �.--ri kHIJ L(y„WVM�141a <br /> SAN JOAQUIN COI.INTYPUDLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 344 EA5T WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 941 i202 L(J <br /> (209)468,42 <br /> PUBLIC RE> CORDS RELEASIE APPLICATIM4 <br /> APPL,IGANT IMYt�� f! ��_ '�_Or� _ --- 0{J$iNE.,i3/AG>wniCY i y�! ir1�✓L L��C3`rA- IGS <br /> ADDRESS � CSvl47CC <br /> PHONE �'� a��i IUA�j FACSIMILE <br /> rE52 <br /> TNTATiVE,'APPOIRTKENT DA [ <br /> Tfi r I . TIME <br /> (Pi ease give 1 to 10 bust e�s f da of application Submittal) <br /> CHECx 301% TO EXPS-01TE REQUEST-447.OI)F/u�£J1 liEQtJEST PR CES EI)IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT `. DA'T'E C '�'^�� <br /> FILE ADDRESS 11!18 GIDE F.IM STAFF WE ONLY <br /> PRDGPAM ELEAlENTS SEARCH <br /> c .1i a <br /> (�7 i + f' c !�1 ?S� MI <br /> 6 <br /> 5040 I/,,13G <br /> ENVIRONMENTAL HEALTH )[VISION FTL.ES <br /> UNDERGROUND TAMC(US73 CLEANUP 41TE{LOP) 13 HOUSING ASATEA EMT G SOLID WASTE FACILRY <br /> Ci OTHER CLEANUP SITE(NOVA-Wl Q Riot}FACILITY CI SOUP WASTE VE MCLJw <br /> O UNDERGROUND TANx(moNirORINGfumoyAL) 0 000 KENNET.. Cl DAIRY <br /> ❑ HAZnFt QVS WASTE GENERATOR Q CHICKEN RANG Q PKGTRF-ATME14YPL MT <br /> Cl TIERED PeFwITfED FACILITY ❑ MQTELAWTEL 12 PumpER1'itucKrYAR=iifEm-roo-ET5 <br /> C 7ATTQpmopY PBtI=CING ❑ POQLISPA O LAND USE APPUCAMN SI7I8S <br /> C MEDICAL WAA7E FAC8JTY Cl PURUC WATER 5 TEM ❑ OTNER(PI ZA56 41KCIFY A90VE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list alcove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209)484+(1138 or mail to the <br /> atldri3s Indicated above. <br /> 2. EI I16wilt notify tho applicant if arty EHD files exist Art appolntinent forreview will be confirmed <br /> approximately five business days but no Tater than to '(10)days after receipt of application.-The tiles <br /> will be held for a maximum of five business bays for view. Appointments should be schedvied <br /> accordingly, <br /> 3. A file that Is actively being worked an by EHD staff miy not be immediately available for review, Anew <br /> itppllcation may be submIttea when tris file is avxilabl 3. <br /> 4. Any file not returned in the carne condition as releaso I will be reorganized by EHD staff at the expense <br /> of the applicant. f=uture tale revleWs by the Same a PPI cant may require a$8T.00 deposit prioet0 revieW. <br /> �. <br /> *TENTATIVE appaintment dates ritual be confirmed with Wil)staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day_ <br /> iUON1-1 MED APPOINTMENT DATE TIME <br /> PATE CONFIRMEQ PHONE FAX INITIALS <br /> VIEWED YES NO REVIEW]DATE <br /> pt IA AIN07M <br /> t <br /> TOTAL P.02 <br />