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1i <br /> rn�U'" .`;-L'i7l:.iG 11::� i"I-•1J1`l= 1.V11'l�N',_, LHU8 :), il'ff._ 1k�V - iV-I1f_v: -j i'."UI' vJi <br /> 08-14-21 0 10:29PM "•`� TO 1559---5S7126 P.01 <br /> CF%%10 <br /> > E.F�pL4AG■41MYCR <br /> SAN JOAQUIN COUNTYPUBLIC 14EALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION f <br /> 3-34 EAST WEBER AVENUE,THIRD FLOOR �� ! <br /> Au 4 200 ST(09 ON d CA 02 <br /> ENVt � ��� K ASSN PUBLIC RECORDS RELEASE APPLICATION <br /> CA14T .7�274 120 V—/ aU51N2331AGENc�+ <br /> ADDRESS <br /> I;HONE 2 4 Q� j' FAG3t10ll F_ <br /> f <br /> I <br /> TENTATIVE'APYoINTWEKr J7ATE �� TIME <br /> (Please give 7 to in buail7 n days from dale ef applleation submival3 <br /> CHECK BOX TO EXPEWE REQUEST-$87.40 FEE--REQIIEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPUCANT�. �� DATE <br /> f <br /> FAQ ADDRE45 THIS SJOE Fly STAFF USE ONLY <br /> 5 F r a Kt� PROQRAM EUMENTS SEAR= <br /> S� o - 23b 2, ULf -2-91 <br /> a s okd t - sb <br /> Z D 2 1 <br /> N 0 S l-9. <br /> 5 �IGMsti,�� 5. i o <br /> 'l.�f (;. �a041 'LZ�D <br /> ENVERommr:NTAL HEALTx UMSION FILES <br /> UNDERGROUND TAMC(U3i) •l.1_ANUP SITL(LOP) 0 HOUSING ABA9'UFNT 0 SOLID WASTE FACUT-f <br /> arms t CLEANUP SITE(@IO 4_0P) ❑ FOOD BAC>I M 0 SOLID WASTE VEHICIIFE <br /> UNDERGROUND TANK(UC1Nrr0R1NWFtl1M0YAL) 0 DOG KENNEL to DAIRY <br /> KAZ04WOUS WASTE GENERATOR ¢ WOKEN RANCH D PKG 1%MTNENT PLANT <br /> P TIEREDPERndriTEDFAGIUTY 0 m0TE11hioTEL Cl PUMPER TRUCKIYARDiCHEMTOSL� <br /> 0 TATTODISODY PEIRCING 0 POOLMPA - 0 LAND{JSE APPLICATION WES <br /> [7 MWICAL WASTE FACILITY 10 PUBLIC WATER SYSTEM CT OTHER(PLEAD SPECIFY OYF.j' <br /> i <br /> ji. List up to ten addresses In titre space above. Select thin type(s) of fills from the list above by checking <br /> the appropriate box(es). At least one fie type MUST be selected. Fay ta(2fl9)4&4-0136 or mail to the <br /> i address Ind4e-ated abavt. <br /> Z, END will notify the applicant if any EHD fitas exist. An appointment far review will btr Gortfin;n d <br /> approximately five business days but no later than tan(10)days after recaipt of application, The files <br /> i will ba held for a maximum of five bl.Wriaas days for review. Appaintmerits should be scheduled <br /> accordingly. <br /> A fife that is actively being worKed on by EMD$Ufl may not be immediately available fur review. A new <br /> application may be submitted when the file is avallabla, <br /> 4. Any file riot returned In that same condition as ralwawd will be reorganized by IEHD staff at the expenas <br /> of the applicant_ Futuna 51c reviowS by the lama applicant may require a$87.00 deposit prior to roviaw. <br /> b. "TENTATIVE appointment dates must be confirmed with FHO staff. <br /> �5. Applications received aster 3:00 pm will be processed the next I Ualness slay, <br /> k <br /> 1CONFIRMED AFF"OINTMEN'r DATE TIME <br /> L <br /> PATE dONFIRMED PHONE FAX INITIALS <br /> f <br /> rREVI>~kD YES NO REVLEiM DATE <br /> JW 04 14 <br /> (]FAL P.01 <br />