Laserfiche WebLink
11/10/2000 12:42 209-579-2225 MODESTO ATC PAGE 02 <br /> 57912 P.2c <br /> FROM � 70 _ <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES M <br /> NOV 10 2000 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRON LTH STOCKTON CA 93202 <br /> (209)468-3420 <br /> E � PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSfAGE �1� . <br /> NCY v 44 Sll Cto tAs y� <br /> -� PIIONf � <br /> OctFACSIMILE Z <br /> 5�- ZL't ( �� <br /> rl. . . <br /> TENTATIVE*APPOINTMENT DATE PO. w t K TIME <br /> (Pians,glre 7 to 10 business day$from date of ePPII"00,i submittat) <br /> �ZICHIICKSOX 70 FXPEOITE REQUEST•S7SA0 FE -REQUEST PROCESSED IN 3 BUSINESS DAYS I <br /> SIGNATURE OF APPLICANT b'k ' Va " A"'_ DATE <br /> FILE ADDRESS O <br /> �VAto OF < O <br /> l m-ailn Ct.�i� ru} S K4o--+ s <br /> I cl'� ss��n o siwccl StOLr1a•n <br /> '� 4l tN. C ✓4..✓ 0 4uciclan ( , , <br /> �1 yy�7 - L rt-t✓ Wa <br /> 1'� a�-1rt c S+v-Lt-F ki4n � <br /> i(♦A •f�-tvl So.+��. Lolh t S �K4u 1 / e e <br /> x/11 <br /> 1� t1E r W lee to <br /> o,�tr YeIG4.Sc—p¢y ;d ETD <br /> EN VI NMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK WST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY NQ(/ , <br /> OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY t7 SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PUNT <br /> ❑ TIERED PERMITTED FACILITY O MOTELMOTEL ❑ PUMPER TRUCKlYARD1CHEM TOILETS <br /> M TArTOOISCOY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1 List up to ton addresses In the space above. Select the type(*) at files from the list above by checking <br /> the appropriate box(es). At least one file "a MUST be selected. Fax to(20,91 464.0158 or m I to the <br /> add In ' v <br /> 2. EHD wit( notify the Rpplicant it any EHD 11193 exist An appointment for review will be confirmed <br /> approximately five business days but no later than tan (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 submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expens9 <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6' Applications received after 3:00 pm will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> \1 N ♦ OtdSga <br /> TOTAL P.02 <br />