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10/11/2005 10:39 916-7864 GOLDER ASSOCIAT PAGE 01/01 <br /> 1e/11/LU05 10:22 464018 , <br /> E]vvlROhd7EMAL IE <br /> r."vau - PAGE 01 <br /> i SAN JOAQMN COUNTY <br /> 1+AmONMTkNTAL HEALTH DEPARTMENT <br /> t I <br /> /005, 304 East Weber Avenue,aro floor, Stockton,CA 95202-2708 <br /> r 1 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www 41gov.ory}ehd <br /> S )�,' PLTI{ <br /> PCn !GE" PT.TBS..IC RECORDS RELEASE APPLICATION <br /> APPUCMT: N4A��e e� (•xa�tl to 5 sus sstAar�+eir: t lder L'�s Oa0.Aes Mc . <br /> ADDREta: IOOnv�oribe� we_ _ S}P 3$O <br /> PHONE(1rW9�1.- �Ia` nu?�. PHQNE(2): FACSnt(LF: glb'TSb'ZV3� <br /> TENTATIVE'APPOWTUM DA.TE: Tmm• <br /> (Please 1II0W 10 beakless t*s from date of appacogn submhW-srad t ony-must be eonram" <br /> ❑ CHECK BOX TO Fa(P6l)1TE 1tFOUEST-9911 FM(CASH OR CHECK ONLY)-REQUEST PROCFS IM IN 3 6U5(NESS DAYS <br /> l©NATURE OF APPLICANT DATE I o-I 1-0 t7 <br /> UNR DI9TWBUTION r3 UNt1 ❑(hAt i R 6 D Unae ❑ 0dW(elyd MNClrSWmape) <br /> FILE A1313MS END USE ONLY <br /> aenro!>R StreetNan» Ct4' <br /> 2. <br /> 1. 112q S S <br /> 3. <br /> s. <br /> L87. <br /> p. <br /> 'Specific Date Range of In(ortnagpn Requested:From 1'1'10 to des y <br /> ENVIRONMENTAL HEALTH DEPARTMENT FiL.ES <br /> U ==TAW(u9T)VtVM r9rte(lAp) ❑HOUSMAR&T:IMI C18QWWAstr:FAcamfveKME <br /> i <br /> �Orrm DL6ANUP trm(NM4.OP) C3F000 FAFeny ❑WAMTM <br /> )A UNUMORMM TAW(M�tAL) 0 Doo t 0 DARVC <br /> (3 HArARD0KWA$T2G0e3iAWR 130 WACTEwATmTREAn%KTFLMT <br /> 0 TOM PeRwr E0 FAC4M 0 nbTa.KloTal 0 PLgomTM)0Kn'.AaD0mTMm <br /> O TAITOWSM PtMCWG "0 POOISPA 0LAMUSSAPPPOAT AMM <br /> M MONCAA WASUFACanY 13 QTM WLWESP�7Fh <br /> ykLLAN 8*Wp&WTREOOroca AREAYALAKErmpxyoV. Mo"Y4�ftAT"AM-A:aOPr( • A%dCltmm HOLDAM. <br /> 1. l.tst up to in addressee in the space Above. Select the t0o(c)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. E9K r V 463 0738 9r MID f;9 the address <br /> 1ndi(mted above. Address ranges will not be accepted—for additional sasistanee With file addresses,contact <br /> the HHD.Applications received ahor 3:00 pm will be pracessed the next bualnesa day: <br /> R. The WO will notify the applicant If any EHD fifes exist An appointment for review will be confimred <br /> approximately ten(10)days after mmlpt of application. The filet will be held for A mazlmum of live bushiest <br /> dads for review. Appointments should be scheduled accordingly. <br /> 3. A file that Is acttvaiy being worktut on by EHD staff may not be Immediately available for review. A now <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released vYiii be reorganized by EHD staff at the ex"119e of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposltprior to review. . <br /> EM4"� <br /> M <br />