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" " `•`� SAN JOAQUIN COTINTY <br /> RECEV IED ]ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3r4 Floor,Stoc Wlo CA 95202.2708 <br /> Z005 Telepbeoe:(2109)468-3420 Fax: (209)464-0138 Web:www-sjgov.orwebd <br /> ENVIRON�9ENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> CA `I Li I <br /> ADDRESS:_ts _S . 8 Sf're.r.! ){o-�w — <br /> V"ME(t):_Sl0' �u7-g88S * PHONER):_�a <br /> 33RuNI <br /> a fSg � FAc3LE: SlD-884 S371 <br /> TENTATIVE'Mp0iiinm- i GATE: <br /> (PNate allow 10 tw0lnets d►ya hTNM 074 of spMicatlm iuMnlOAd•'iMOrUv!any•must a eonrPnNd <br /> CHECK BOX TO EXPEDM REQUEST•$03.00"A(CASH OR CHRX ONLY)-REQUEST PRAGEESEO 4N 1 BUS 5 <br /> S1f3NATa.,OF APptaCANT _ DATE <br /> UtO7 CLST1ttBIUT10R 0 unitt o uns a X3 WAf 0 una$ 13 UMt 1 Cl Oaw(skctroNT:M1I+LsfaTaRs) <br /> FILM CRESS EHD USE ONLY � � <br /> 1. lJ.sfco�a �9 o <br /> W� Wim. Ar✓ � zF�� 3 r <br /> 5. wTs..^. <br /> -- <br /> 0. - -- -- - - A - <br /> Speaint Pate Range of Information Requested:Fr.. to _!Y L-•�-' <br /> ENVIRONMEN HEALTH DEPARTMENT FILES , <br /> B,tIMbeRWeWNa T.we 1511 CLEMWF&TE(LOP) �iniwrxr ❑StxlC WlsTE FAC*M . <br /> IY� ,Beyn 4truur SaTe(Ho+-LAP) W r,u:am o WAstE Tae <br /> B(UWa� *o NID TAM pai?IETORNTO/RE1pVA1) Kamm C7 DArir <br /> ,44AlAft"W4P«(F9WRATOR C4C4CK1k k PAWN 0 WASTEWAUA TREATMENT PLANT <br /> 09i TURA®P&AWnao FAca.m 3 dofMioTt� 0 LANOUe a AmT uRn1CHLM TrALA[rr <br /> O TArrowso0Y pew, a x. ' "J PooIJSPA L7 LAND Use APMucATtON&TEe <br /> Q ltroiCAL WAaTC PAZUTT f]Orim(PLOW$PKWY) <br /> Wal iro SE/nC PamMr ARE AYALMU FOR RKVKNV- MagAYFMAY 1:00 Au-a:OW9 - Fxcumuai HatNAT'0. <br /> 1. List up to ton addo"ries in the spaco above. Select the typels)of files from the get above by Ch"king the <br /> appropriate box("). At Nast one file type MUST be selected. Fax to(zo9l Zt 33 or main to jhg address <br /> In-dMt29 a e, Address ranges V411 not be accepted-for sddtttonal aaslstAnce With file addrcssea,contact <br /> the EHD.Applications received Aller 3:00 pm will be pfoaeesed the next bualness day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application, The files;will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly, <br /> 3, A file that Is actively being worked 00 by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the fila Is available. <br /> 4. Any file not ratumed In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require it$93,00 deposit prior to review. <br /> T�.•ua. <br /> I9 39Vd 1V1N3WN0JIAN3 SVa3 66E598Ez`Z/6T/L0 <br />