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^U7-5 /t1—: <br />MODESTO ATC <br />PAGE 01 <br />D SAN J ENVI N COUNTYpUBLIC <br />ENVIRONMENTAL HEALTH SERVICES""' "" <br />304 EAST WESER AV HEALTH DIVISION <br />STOCKTON C UE, THIRD FLOOR <br />202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE <br />APPLICANT Jig+•, K'vN erfi APPLICATION <br />ADDRESS S .L If <br />1 <br />SINEp'�S/AGENCY_ &r T )�ITJ <br />,I/ <br />PHONE OaCnO�'F�[ <br />� <br />/ H <br />FACSIMILE <br />TENTATIVE• [2.pC1 S•�.o�_Z�Z� <br />APPOINTMENT DATE 10 — <br />(PIC4sC Eli *OF <br />,., LIZ u <br />(� ' °'i^�� r: r, d,l� o TIME fO,S.I PERMIT/SER _EESTH <br />CHOCK PDX TO,CXPEDITE REQUEST •' PPIICaIICn �u6 Itai) <br />SIGNATURE OF ,�E REq sTP <br />APPLICANT / /� "j_ ASE N pU51NE55 pgyS <br />DATE 10-4r- 0 Z <br />PROGRAM ELEMENTS 5 �ARCH W,',' <br />L <br />UNDERGROUNDENVIRONMENTAL HEALTH DIVISION FILES <br />OTHER CLEANUP SITE (NON-LOP)ANK N5T) <br />SITE LOP O <br />D� UNOERGROUND TANK (MONITORING/REMOVAL ) CI HOUSING FACILADATITY ENT <br />FOOD FACILITY O SOLID WASTE FACILITY <br />O HAZARDOUS WASTI: GENEFtgTOR i DOG KENNEL O SOLID WASTE VEHICLE <br />0 TIERED PERMI/BODY T4 D FACILITY C3 CHICKEN RANCH DAIRY <br />0 TATTOO/BODY PilIRCING O MOTEL/HOTEL O PKG TREATMENT PLANT <br />MEOICAL WASTe FACILITY 0 POOUSPA O PUMPER TRUCK/YARD/CHEM TOILETS <br />O PUDLIC WATER SYSTEM Cl LAND USE APPLICATION SITES <br />�• List up to ten addresses in 1110 space above. Select the type s of (1❑Ie5 HER (PLEASr SPECIFY rom list above A checking <br />the appropriate box cs . P ( ) <br />( ) At least one file type MUST be selected. Fax to f209) 464-0138 or mTil to the <br />address intlieait! hove, _ <br />Z' EHD will notifythe a <br />pplicant if any EHD files exist. An appointment <br />approximately five business days but no later than ten (0) days afterreceipt of areview 1pplical be hiofn. Tho tilts <br />irm d <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 maybe 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 />If 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 />EVIEWED PHONE FAX INITIALS <br />oc H a�wmo YES NO --�� <br />REVIEW DATE <br />