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00/29/2003 15:23 209-579-2225 MODESTO ATC PAGE 01 <br /> \ <br /> /DATE RECEIVED EHO LOG NUMBI <br /> • SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Aye r <br /> h� Il(209)468-3420 Fax: (209)464-0138 Web:www. consan oaquin.ca.us /chd <br /> AUG 2 9 2003 <br /> RpA�S� 1t PUBLIC RECORDS RELEASE AAPPLICAATION Y <br /> APPLICAN�T�S /s-�( Sf // Ave. BUSINESaIPAENpCY: �/}T_f7�C r/S�f a1/a)p<tJ�..Lil o <br /> ADDRESS: <br /> 7�r�eII� Zorlc PRU1•I ASNr)-t'. U /pp- deaf C4 IJ 3Jr� <br /> PHONE: d"-T_ 5-79- 2e?� FACSIMILE: S77 - �.�,a•S <br /> TENTATIVE"APPOINTMENT DATE: Se�� /2 .ZV03 Time: 08W <br /> (Please allow 10 business days from date of application submittal) M4� 4 <br /> _CHECK BOX TO EXPEDITE REQUEST-590.00 FEE�-RRE�QUEST PROCESSED IN 0 BUSINESS DAYSSIGNATURE OF APPLICANT � Gua/Jyc+. D <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> Unit 1 <br /> otf( 'r--- ❑ <br /> 1. sv«t O SncP Thp a a .rnitca t>rJ3L <br /> sa.a ne PM& Cr, +R<a Q. 3 jUnit2yy00 s c ❑ �p9�8�] �t v a ect r33�70 <br /> y;4 IL 414. <br /> Lit <br /> i. street a i S`4 ci 4"2ACA QSS?6 e. 3.,.t ❑ <br /> 10 3"M <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Gil UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Q OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OS UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATPOOIaOoY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) _ <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkln <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)484-0138 or mall to th9 <br /> address Indicated above. <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 filet <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 of <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 expen: <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revit <br /> 3. '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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> HD"42400 - <br /> NVIOOi <br />