Laserfiche WebLink
09/11/2002 16:07 209-579-MODESTO ATC PAGE 01 _ <br />9 <br />no �aL�°I G) <br />ISCIN COUNTYPUBLIC HEALTH SERVICES no - rte(( %IS <br />REC ENVIRONMENTAL HEALTH DIVISION U CN_ III l IEl_Q� <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />SEP 1 2 2002 STOCKTON CA B5202 SEP 1 2 2002 <br />(209)466-3420 <br />ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br />PERMI <br />APPLICANT O <br />,--6-_U_SINESSSIAG%EN�CY <br />ADDRESS �12Q <br />PHONE%A2 <br />�1 ��/ ` 72 �FACSIMILESL <br />' <br />TENTATIVE' APPOINTMENT DATE" � <br />(Plc349 Dive 7 to10 <br />© CHECK BOX TO.FXPE01TE REQUEST - <br />SIGNATURE OF APPLICANT <br />4TIME _�/ <br />fop ICalI0e :U6m4lal <br />t 7 BUSINESS DAYS <br />-tv <br />DATE <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK LUST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />X OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORING/REMOVAL) O DOG KENNEL O DAIRY <br />CI❑ HAZARDOUS WAS'fB GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br />TICKED PERMI7Ta FACILITY ❑ MOTEIJHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br />❑ TATTOO/BODY PJACING CIPOOIJSPA - O LAND USE APPLICATION SITES <br />❑ MEDICAL WAST9 FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the $Paco above. Select the type(s) of files from 1110 list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to <br />address indicated above (209) 464-0136 or mail to the <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. Future file reviews by the same Applicant may require a $07.00 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 <br />DATE CONFIRMED <br />YES <br />TIME <br />PHONE FAX <br />NO REVIEW DATE <br />INITIALS <br />a <br />V <br />1 <br />• <br />��.. � <br />� <br />•, ,• 11�. siwt�.'!�!�"1���IYIUII�/I�1(/►' <br />T <br />.. ... � <br />�uirgr�L�fi�lit�►� <br />r . <br />ii���1�c�' <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK LUST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />X OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORING/REMOVAL) O DOG KENNEL O DAIRY <br />CI❑ HAZARDOUS WAS'fB GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br />TICKED PERMI7Ta FACILITY ❑ MOTEIJHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br />❑ TATTOO/BODY PJACING CIPOOIJSPA - O LAND USE APPLICATION SITES <br />❑ MEDICAL WAST9 FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the $Paco above. Select the type(s) of files from 1110 list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to <br />address indicated above (209) 464-0136 or mail to the <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. Future file reviews by the same Applicant may require a $07.00 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 <br />DATE CONFIRMED <br />YES <br />TIME <br />PHONE FAX <br />NO REVIEW DATE <br />INITIALS <br />a <br />V <br />