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MODESTO ATC PAGE 82 <br /> 2 <br /> 05/05/2005 15: 30 09-579 <br /> < F1 � <br /> DATE RECENED 7 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 2005 MAY -5 AFS 7: 28 <br /> (209)468-3420 - <br /> PUBLIC RECORDS RELEASE APPLICA-nn,0AOUIN COUNTY <br /> APPLICANT DAV i{7 SCA2k Y1(�EI7- BUSINESSIAGENCY ATC, ASc Oo§, 'raL S D`LPARTtiENT <br /> ADDRESS 11111 L^NE PALM AVE . maw i-b ,S4 a5Ts35 1 <br /> PHONE(2CA') FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE S-,ZO. OS TIMEIO I?1 <br /> (Phase givo7tol0business da ftomdys of application submlKnl) Ill AY 6 <br /> El CHECK BOX TO EXPEDftE REQUEST- 9 0004FFEEE —RIRRIEOUES7 P O ED IN 1 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT to h , DATE SOS •aS <br /> FILEADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 93'1 A N S <br /> °162 usr� w 5-I� <br /> b NAMrAE2 LN E T`� Hw O <br /> 162A I-A.M S1 <br /> N <br /> 1 <br /> W� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> N UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 11< OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 91 UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> O TATTOOIBODY PEIRCING ❑ POOL/SPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to theg0p <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 files <br /> 00 <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 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 /> EHD M-0x-0 4 <br /> MM003 <br />