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11/10/2000 12:42 209-579-2225 MODESTO ATC PAGE 02 �_ G -Ob 91'4 jF1M FRDM i0 57C3 -5 P.EL- SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES NOV 10 ZOOO ENVIRONMENTAL HEALTH DIVISION �. 304 EAST WEBER AVENUE, THIRD FLOOR ENVIRON LTH STOCKTON CA 95202 (209)488.3420 E'i 4A PUBLIC RECORDS RELEASE APPLICATION I - 't/A,L,'� BUSINESS/AGENCY P)iONE � U° 5 -1-c'f - -LLT FACSIMILE zccf 1( � TENTATIVE" APPO(NTMEHT DATE �V Q7�' `�`�'-�'TIME IPloose give 7 to 10 business days trom 4ate oI appilcation submi=t) CHECK BOX TO "PEDITE REQUEST- $711.00 FIEI¢ - REQUEST PROCESSED IN 3 BUSINESS DAYS V SIGNATURE OF APPLICANT �� DATE ENVIRlnNMENTAL HEALTH DIVISION FILES �UNDERGRWND TANK (UST) CLEANUP $ITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID VVA5TE FACILITY NOV OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY t7 SOLID WASTE VEHICLE 0 UNOERG ROUND TANK (MONITORINGIREMOVAL) 0 POG KENNEL ❑ DAIRY O HAZARDOUS WASTE OENERATOR t7 CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY O MOTEL/MOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS O TATTOO/BODY PmRmNG ❑ POCUSPA 0 LAND U3E APPLICATION SITES C] MEDICAL WASTE FACILITY ❑ PUeUC WATER SYSTEM d OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses In the space above. Select the type(a) of files from the list above by Checking the appropriate box(es). At least one Ole type MUST be selected. f Ix to 09) 454.0138 or mail to the address Indicated above 2. EHD will notify the applicant if any EHD Was exist. An appointment for review will be Confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum or live business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review, A now application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, S. Applioations received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED REVIEWED NO TIME PHONE FAX E INITIALS TOTAL P.22 �t1\f✓A•i"sL.��_ .... �„�� a1'11�t1�//^iw//*))i�1�C�L'/.?��yQ�r��i�7��.r��'�'�� �. Re RZ "46 Sam I won a.• iZli�'r.Z��r _ .. �sE: 1. Z87 a w ENVIRlnNMENTAL HEALTH DIVISION FILES �UNDERGRWND TANK (UST) CLEANUP $ITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID VVA5TE FACILITY NOV OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY t7 SOLID WASTE VEHICLE 0 UNOERG ROUND TANK (MONITORINGIREMOVAL) 0 POG KENNEL ❑ DAIRY O HAZARDOUS WASTE OENERATOR t7 CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY O MOTEL/MOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS O TATTOO/BODY PmRmNG ❑ POCUSPA 0 LAND U3E APPLICATION SITES C] MEDICAL WASTE FACILITY ❑ PUeUC WATER SYSTEM d OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses In the space above. Select the type(a) of files from the list above by Checking the appropriate box(es). At least one Ole type MUST be selected. f Ix to 09) 454.0138 or mail to the address Indicated above 2. EHD will notify the applicant if any EHD Was exist. An appointment for review will be Confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum or live business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review, A now application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, S. Applioations received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE DATE CONFIRMED REVIEWED NO TIME PHONE FAX E INITIALS TOTAL P.22