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07%30%2003 11:30 20.9-579-2225 MODESTO ATC PAGE 01 <br />EHD LOG NUOMR <br />DASE RECFJYED SAN JOAQUIN COUNTY • ENVIRONMENTAL HEALTH DEPARTMENT3 2��3 304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202AO5 <br />(209)468.3420 <br />r!t"L')'PUBLIC RECORDS RELEASE APPLICATION <br />t <br />APPLICANT 3-1 . KvN er BUSINESSIAG /ENC11Y� s� �S <br />ADDRESS ll-,iL La'^ IP.,Iv-, e <br />PHONE Zoq-57c%'221( <br />FACSIMILE "SV9�22'Z) <br />TENTATIVE' APPOINTMENT DATE , TIME <br />(Please give 7 to 10 business days rrom Gale of appllGallDn aubmklal) A I <br />CHECK BOX TO EXPEDITE REQUEST - $89.90 FEE —REQUEST PROCESSED IN 3 BUSINESS DAYSU (•, 131,J/ Z��lj3 <br />DATE (� <br />SIGNATURE OF APPLICANT <br />r <br />7-7 <br />1♦ -1♦ t =ii V ZZ t S -W& inn <br />L 1■ <br />SII IiINIRAII JI■1-�1� It�Ili� � <br />`� v m � 1Z911IL�U1■■� <br />1♦�fililZl�� <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENTD� SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY '� SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br />0 TATTOO/BODY PEIRCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY 0 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 checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the <br />address indicated above. <br />2. EMD 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 immedlately available for review. A new <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. Future file reviews by the same applicant may require a $89.00 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 YES NO REVIEW DATE <br />MW203 <br />