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83/27/2006 09:26 13107984"''1PAGE 01 <br /> k <br /> HEAL'r <br /> ' pgr 02 <br /> F11/03/2003 35:16 4640139 � '� 1=1�1V" IR0l�INIE4dTAL ,��. I� <br /> SAN JOAQUIN COUNTYPUBL1C HEALTH SERVICES t <br /> ENVIRONMENTAL HEALTH DIV1SiC?N � I <br /> 364 FAST YV>~M M AV>=t4t1E,THIRD FLOOR <br /> 2006 MAR 27 AM -8* 39 - STOGKTON CA 95202 <br /> (205)+466-3420 <br /> s� J/`� ��((`��`q[ Cp � "ffil6LIC.RECORDS RELEASE APPLICATION <br /> AppUfC qNT J V I- t5: C E L i-a r-1 1 l3usigEssrAagNeY A F—7 <br /> AopitESS E50o C'AM 1NO DtAe5Lc7 <br /> 'PHONE ��57 2 3Lod x t 3 FACS`ttww tcq-. <br /> TP14 TATIVEP APPOINTIUCNTDAr1r � i Q'(�p TIME <br /> (Plaa30 ONO 7 to It busitmia,days from slate of appnaNton atrbr 110 <br /> SI(CRECK DOX TO EXPEDrM REQUEST-$Oluu r-EE-RL:QUEST PttOCESSED IH o BUSINESS CLAYS <br /> *SIGNATURE Of= APPLICANTDATE _s' 1 <br /> i <br /> F'A-C_AD0R1=5S THIS SIDE V STAI=F Use Dia-7 <br /> AA <br /> PFtoopAM FLEMr.tM SCARCM I y <br /> 4!5o F. 10*1n re �r <br /> 3 E . ld4r, <br /> yc 14 1 i—r Its*a $ r c-+ <br /> �i t ref A= # � <br /> i <br /> ENVIRONMENTAL HEALTH DiVtSION FIL <br /> • . tIAIDEK0110*0 TAl*(UST)CLEMUP SITE 0.00) In HOU$1MG ASATEMgNt 01.10w kq <br /> OTHER c;LeAklir STT6 I!'tUH•LOP) 0 FOOD FACIVTY SOGD W iltC <br /> "lam umt)ERr toir do TANX fROIiTTORINVAEMOVAI,} D DOG KEVCft. d DAIRY. <br /> 4 A HAZARDOUS WASTF GENERATOR GIiIt:K81f RANCH HATHIE t 1lH'r <br /> ITl: <br /> nr_REB Rr:Ftm M0 FACIL" IKaIFt1r#l7TE4 uG D[G4kT YOILETS <br /> rAI rOOPRd>}Y PG1RC1r[6 POO t7 4ATltF PU H s5 i <br /> L,MEoICAL WASTE FAC[1,r rY D 4 fHEA E SPSGIPY A130VE1 <br /> _ 1. List uta to ton addrass. . �!0 spa J.opo. ��Ct the typ of files a 115k above by chocking <br /> the appropriate Iso t Icast a le type, �'be sel° d, 209 464-0138 or m�Il t0 !hG <br /> address intii+:`�! d <br /> 2. EHD will notify th t if Hp filar exist. If1 anent for review will bo cortfirmod <br /> a�pproximatoly fIv srn t later than ton-(i4j days after rgeeipt.of application. The files <br /> • will be hold for a lrnt or review, Appoirltmatlt;s should be schudulad <br /> accordingly. <br /> 1. A file that Jr,activ y buihu war on by E140 ata ay not be Immedfately availgblo for review. A new � <br /> appli=uc5n may kx ,submit#ad wF1 a f#Ia lz avaltable. <br /> 4. Any file not returned lh tho sante'eo ditlon as released Will Fee reorgarwlzed by EHL}scarf at the axpartse <br /> of the applicant" Future file roviaws�by the sante applicant may require a $80.00 deposit prl4r to Tcviow. <br /> 5. *TENTATIVE appointment dates must be confifted with FM staff. <br /> 6_ Appiicoilians reaeivud after 1:04 pm will be processed tha liext business clay. <br /> CONFIRMED APPOIRYMENT DATE. InME _� �....��..... <br /> DATE CONF1RMEQ _ __-- --_ - PHONE FAX INrr[ALS <br /> RMEWED YES NO REVIEW DATE <br />