Laserfiche WebLink
\ 09/11/2002 16:07 209-579-2"5 MODESTO ATC PACE 01 _ <br /> V ~ \n � ll Yrl 111141. . <br /> REC���I�°I r� G) S NNUIN COUNTYPUBLIC HEALTH SERVICES �o �(� <br /> - ENVIRONMENTAL HEALTH DIVISION u�� \� ��� I <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 2 2002 STOCKTON CA 95202 SEP 12 2002 <br /> (209)468-3420 <br /> ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> PER MI - Z <br /> APPLICANT O BUSINESSIAGENQpCY <br /> ADDRESS +P <br /> PHONE FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE_ Shd�ol TIME : <br /> (Plcaac alvo 7 to le buciRe"day& Irol C of ap ICallon:Ubndllal) <br /> CHECK BOX TO,ExPEDITE REQUEST- 7.a -QUROC ROC*S D 1 J BUSINESS DAYS <br /> SIGNATURE OF AiPLICANT DATE 9 1177 <br /> rJL <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> \' PROGRAM ELEMENTS SEARCH <br /> r, <br /> J oO <br /> 13 & o <br /> OCT <br /> J w _ <br /> O Ij6t4Stth, Ajd, <br /> ,d <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> O-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ,X OTHER CLEANUP SITE(NON-LOP) . ❑ FOOD FACILITY ❑ SOLD WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> 0 HAZARDOUS WAS-Fr GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMIT-rDFACJUTY ❑ MOTEIJHOTEL ❑ PUMPER TRUCKfYARD/CHEM TOILETS <br /> O TAT-roomoDY PURGING ❑ POOLISPA ❑ LANE)USE APPLICATION SITES <br /> 0 MEDICAL WAST9 FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List Up to ton addresses in the space above. Select the type($) of files from the list above by checking <br /> ttis appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 Or mail to the <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 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 expense <br /> of the applicant. Futuro file reviews by the same applicant may require a$87.00 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED + YESNO REVIEW DATE <br /> r---r-�a As o— * <br />