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08/16/2002 11:44 209-579-2225 MODESTO ATC PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 3 ( D <br /> a 304 EAST WEBER AVENUE,THIRD FLOOR D <br /> C�j L C' <br /> STOCKTON CA 95202 <br /> (209)468-3420 AUG 18 ZOOZ <br /> PUBLIC <br /> ` RECORDS RELEASE APPLICATION <br /> I'- <br /> APPLICANT 17. J�t.W Ct�n -t-) BUSINCSS/AGENCY AXL 4Sta<t.a�k& ENVIRPER�rnITIeFR\(ICES H <br /> ADDRESS A'jt.A.rt Sa lik (3 , Lk-& y"4,<q Qk `f S 3'1 <br /> FACSIMILC_ Za9 j5- Z2Z <br /> TENTATIVE*APPOINTMENT OATS (Dt(?-+Ioma TIME It3aa <br /> (Please DivIL7 Lg 10 bujLU2�A&&/yµfro ,of#SINrSS <br /> ation pubmiltal) <br /> 0 CHECK BOX TO,EXPEDITF REQUEST•$07.00F, --pLEQUEST�RO 1 IDAYS <br /> SIGNATURE OFAPPLICAN7 D/.I,~ U DATE a�l�l-zz_ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> t g4 5 a+A .Trot QlJ . SkoLK4w1 <br /> tj,100T�rk�� Aft 11 <br /> � IoIZ W4,+E ost���t Ja�h�.rc Maier. <br /> Zg9� N ti' AWq' 132 rAa1;5 <br /> We-5F (1 '= 5+rx+, teoc <br /> (oy5 Wtsf CInGd rt110 crfo✓I <br /> � Zt9\ aJ Dr:4t shot-k <br /> 5�FaCtc(-oh <br /> gat iSa Lon1 vw+c 26 40T_ 1 <br /> Leal: ' <br /> .a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> .ted,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ADATEMENT ❑ SOLID WASTE FACILITY <br /> J+S OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENCRATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTqO FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YAROICHEM TOILETS <br /> ❑ TATTOOIBOOY PIARCING ❑ POOLISPA ❑ LAND USC APPLICATION SITES <br /> ❑ MEDICAL WAS-rl FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE•SPECIFY AbOVC) <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> ttie appropriate box(es). At)east one file type MUST be selected. Fax to (209) 464-0138 orFax to 464-0138 or mail to the <br /> the <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 /> will be hFld for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A fete 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 reorpanizad by EHD staff at the expense <br /> of the applicant, Futuro file reviews by the same applicant may require a$87.00 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 /> RCVIEWED YES NO REVIEW DATE <br /> EH 0 14 0 p0 <br />