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09/11/2002 16:07 209-579-2225 <br />MODESTO ATC PAGE 01 _ <br />nD FCE i'\(jI�� S 1N COUNTYPUBLIC HEALTH SERVICE <br />S ( �(�( <br />L I L !~NVIRONMENTAL HEALTH DIVISIOLN mil l <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />SEP 1 2 2002 STOCKTON CA 95202 <br />(209) 466-3420 <br />cnlvmnmMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />PERM <br />APPLICANT <br />ADDRESS III,`Z <br />BUSINESSIAGENCY <br />S+Q _ B <br />SEP 12 2002 <br />ENVIRONMENT HEALTH <br />3 <br />PHONE `I — I FACSIMILE Q <br />/1 <br />TENTATIVE' APPOINTMENT DATL �hfk�, TIME <br />(Pluaisc eiva 7 to /0 business dau fro( c of ap IG"on :ubn ll(al) <br />CHI -CK BOX TQ EXPEDITE REQUEST - 7.0 - -QUEST PROC 5ED ( 9 13U51NE 5 DAYS <br />SIGNATURE OF AiPLICANT DATE <br />�,. — <br />PROGRAM ELEMENTS SEARCH <br />' ENVIRONMENTAL <br />HEALTH DIVISION <br />FILES <br />)9-1JNDERGROUND TANK (UST) CLEANUP SITE: (LOP) <br />0 <br />HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />X OTHER CLEANUP SITE (NON -LOP) ' <br />0 <br />". I w . d1 •�J 1 .�� <br />O SOLID WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORINGIREMOVAL) <br />0 <br />DOG KENNEL <br />O DAIRY <br />❑ HAZARDOUS WASTC GENCRATOR <br />O <br />CHICKEN RANCH <br />O PKG TREATMENT PLANT <br />❑ TIERED PERMITT -U FACILITY <br />❑ <br />MOTEL/H'bTE:L <br />0 PUMPER TRUCKfYARD/CHEM TOILETS <br />O TATTOOIBODY PII&ACING <br />❑ <br />POOUSPA <br />❑ LAND USE APPLICATION SITES <br />0 MEDICAL WASTL FACILITY <br />O <br />PUBLIC wATCR SYSTEM <br />O OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ton addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />address indicated a¢ove. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of application. The files <br />will be held for a maximum of five business days for review. Appointments should be Scheduled <br />accordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <br />application may be Submittal when the file is available. <br />4. Any file not rcturnod in the same condition as released will be reorganized by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $67.00 deposit prior to review. <br />5. 'TENTATIVE appointment dat4s must be confirmed with EHD staff. <br />6. Applications received atter 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />JiN 00 14 9LOOM0 . <br />' ENVIRONMENTAL <br />HEALTH DIVISION <br />FILES <br />)9-1JNDERGROUND TANK (UST) CLEANUP SITE: (LOP) <br />0 <br />HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />X OTHER CLEANUP SITE (NON -LOP) ' <br />0 <br />FOOD FACILITY <br />O SOLID WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORINGIREMOVAL) <br />0 <br />DOG KENNEL <br />O DAIRY <br />❑ HAZARDOUS WASTC GENCRATOR <br />O <br />CHICKEN RANCH <br />O PKG TREATMENT PLANT <br />❑ TIERED PERMITT -U FACILITY <br />❑ <br />MOTEL/H'bTE:L <br />0 PUMPER TRUCKfYARD/CHEM TOILETS <br />O TATTOOIBODY PII&ACING <br />❑ <br />POOUSPA <br />❑ LAND USE APPLICATION SITES <br />0 MEDICAL WASTL FACILITY <br />O <br />PUBLIC wATCR SYSTEM <br />O OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ton addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />address indicated a¢ove. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of application. The files <br />will be held for a maximum of five business days for review. Appointments should be Scheduled <br />accordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <br />application may be Submittal when the file is available. <br />4. Any file not rcturnod in the same condition as released will be reorganized by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $67.00 deposit prior to review. <br />5. 'TENTATIVE appointment dat4s must be confirmed with EHD staff. <br />6. Applications received atter 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />JiN 00 14 9LOOM0 . <br />