Laserfiche WebLink
1©lCvizao: 11:12 ,09_575-2225 MODESTO ATC <br />\ : 11 • PAGE 01 <br />SAN UO•UIN COUNTYPUBLIC HEALTH SERVICES ,.,,.". "• <br />0 #Z0 ENVIRONMENTAL HEALTH DIVISION <br />' 304 FAST WEBER AVENUE, THIRD FLOOR /O <br />STOCKTON CA 95202 <br />P (209)488-3420 <br />UBLIC RECORDS RELEASE APPI ICn71nr,1 <br />APPLICANT_ wl_ {C��y�7 e_r-•r <br />ADDRESS . �BUINESS/AGENCY- --- <br />7 <br />_Ar� <br />O,w <br />PHONE �Q-Z2f Mole i40 <br />-- <br />/_ <br />FACSIMILE" C217C1� SCJ-Z?.ZS - <br />TENTATIVE'APPOINTMENTDATE fU-71_CJ2 TH <br />(Please W"OFCOIE-REQ <br />bu•i TIME lO yrt PERMIT/SERVICES <br />ncs5 ys Ir n dale o ppllwlion :ubnu4ae <br />CHECK BOX TO•EXPEOITE REQUEST <br />�Jy-ST PSE N 7 6USINE55 DAYS <br />SIGNATURE OF APPLICANT T!�-.L�C <br />DATE Z <br />• FILE ADORI=ss _ <br />E/ <br />PROGRAM ELEMENTS SEARCH <br />V <br />0 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />UNOERGROUND TANK (MONITORING/REMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />TIERED PERMilr 4-D FACILITY <br />TATTOO/BODY PtiIRCING <br />MEDICAL WAS'rL FACILITY <br />❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />O DOG KENNEL O DAIRY <br />❑ CHICKEN RANCH O PKG TREATMENT PLANT <br />❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHC-M TOILETS <br />❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />1• List up to ten addresses in the space above. Select the type(s) of files from (he list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />address•indicatrd 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 ton (10) days after receipt of application. The fifes <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />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 />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 $67.00 deposit prior to review. <br />'TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 Pm will be processed the next business day. <br />:ONFIRMED APPOINTMENT DATE <br />ATE CONFIRMED TIME <br />PHONE FAX INITIALS <br />EVIEWED YES <br />0 a vu fm NO REVIEW DATF <br />