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U-1 2"L 2 0 6 1 G d 7 32594,428-r-c' TSG PAGE 02
<br /> VTElis LOG N*XOSEP
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<br /> SAN JOAQUV�COUNTY
<br /> EN'VAONMIff AL IkALTH DFF,,kRT?Vff,1 TT
<br /> 304 East Weber Avenue, 3`'Floor, Stookq,M, CA 952G-2708
<br /> Tc-l-WrOne.(209)468-342-0 Fax. (209)464-0138 Wzt.www,s1gov,org/thdZ<y'e'�
<br /> HEALTHQT Ar
<br /> GES F 171'11C RECORDS RELEASE MIMICATION
<br /> 7
<br /> A Lffi�"042_�A'IAz:_ FAMMAM., 71?si q q V.
<br /> L
<br /> TENT ATIVE* DAVE'.
<br /> cmeas4afiow 10 twulnos.&days frtim dAm of application
<br /> OR cHEcr,ONLY)-REQUEST pnoccr�ssr;vm 3 u7nw:-n
<br /> 0":APPLIC:ANT
<br /> DATE q1
<br /> 410 fj Map Description-
<br /> NVE APPRFW EM 114RE,ONLY
<br /> 7.3 riEI
<br /> .L.3
<br /> fu-
<br /> qe_
<br /> Range of 1,3vrmatjvn Reqrinted:Frorn to
<br /> ENVIRONMENTAL HEALTH DEPARWENT FILF_z,'
<br /> TAW(.U8'1j'%EAMvF V)nr(L(;P) r-)*XMING ABAlT;MENT Sou r
<br /> C,WAS-a.Fj:,;i vryfv*or wLK,
<br /> 13 FOOD FACILITY wp-:§,l-E nFm
<br /> L-''000 KENNEL KOA151'
<br /> AMR <§xcHicKft_ri RwNcm
<br /> ;aWASIEWATER'0TFEA'tVr-.VJTILA'fT
<br /> 71f PAOTELMoTft-L 7_FLvfipERTRuCKrt'.AX0ICKF.%j TvLm
<br /> ED C jU
<br /> 7f, '0
<br /> ;9-LAUP7USE A-FMATRW SIM
<br /> 5V7,cj'Q'45I WASTE FA(,)L*T- C GMER(PLEASE
<br /> VWRLL AND SEPIX rs_RMFF FXCQ,10G ARE IWAILABLE FOR RT;MDY 800 jW_5-04jpM
<br /> .ist Ur.to ton zdcfw.�ui,,in T,�vpacs above. seleat the type(s)of file-9 from the 115t above by chucldrig ap;ropliate
<br /> b,ax-jes). M iwo.,st one me tyme NIU87 be rwlcctnd. Fx to 2o9 -0I n8 or mg I
<br /> _qIdmg_Ln0Lc4jt
<br /> &d;ttW
<br /> rapq1r,L will not bfm
<br /> e acp%wt-for addifforill assl,,4tance with file adclm"- kct the
<br /> QW15 n' t)40Iq,
<br /> es,cp" -_ Addmu
<br /> a;day:b,E' v4ili Llot !MD.AppPuffonT,
<br /> pq-a
<br /> will g co
<br /> appola'Ant If ary EKDNWS exist An appolrIUMIlit f©r bnlMed appr_*yjrr;Itu ta, ,�)
<br /> V't or rmlly 0(1
<br /> 60Y5 after irsnslPt Of aPPII-MbOn. TIVes will b<,held for a MAMMUM of liw- busirw3s days for rev&w. Appointrneri&t.,
<br /> v;hould be scheduled ncor.�,Iingly.
<br /> F. A file thzt,'v,a0voly bvIng wt:*ed ov by EHD staff may not be Immediately atallable fur mview. A new applicaV.9n„ay int
<br /> Whin the jilf!is&Vq'jr,9jblp,
<br /> 4ata,, c'i� not lelurnev,ipthw 3all"n".0flittioll as fvi.=;asecl will be reorganized by EF*rC,g#,aj'gt the"Fqr.,,ccf the I'Ip
<br /> T4 Tg.twmz�by 09 anute applicant ITILly rpf:julre 2$95.00 dePoslt pilfor to roylow.
<br /> EFID USE ONLY
<br />
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