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11/10/2000 12:II42 209-5725 MODESTO ATC PAGE 02 <br /> CTr' yJ T O 57922c5 <br /> FRO^t <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES _ <br /> NOV 10 2000 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONMENT HEALTH STOCKTON CA 95202 <br /> PERMIT/SER ES (209)468-3420 <br /> ,•'. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A�L�t'.RAT ,:IJ•�taN Q� rrIJM 9USINE85/cA+GENCY file ` n SSI/CIS ---- <br /> ADORE89 <br /> .xlv "-,{.T'EN IVF'APPOINTMENT DATE — <br /> ��X/6 (p)aase ylve T to 10 buaine�s days hom 4ate of appeuoion submittal) <br /> , ,lCNECK BOX TO EXPEDITE REQUEST.$79.00 EE –REQU�EST�P[r1t-OCESSED IN 7 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT ��V0�7 DATE (L(IQ C 0"'s <br /> FILE ADDRESS <br /> 17Al a-.OtA C�.n�cy .51.v-u4• S}oCIC Fo-� 3' , ••2 /Lt '• <br /> 1 �'I"t 5.•. �n &A <br /> 4L W. Cln,x.rla✓ uJay, $-FncIC•1-o� ` 3=s.-Y ' �'� •u <br /> Int �,,, St�J{-1n L��.c,CLN $1-,rLLf SI'D t.� 1•� 3f ..3-ln'K-15r <br /> ly��l S�,:i�. tol✓t vt t S{n�KW�-1 �„�`?�,4K� <br /> a: <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C HOUSING ASATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORWGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> �7 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIEREO PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> O TATTOO/BODY PEIRCING ❑ POOL/SPA O LAND USE APPLICATION SITES <br /> L7 MEDICAL WASTE FACILITY C PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Eax to(29,9) 454.0138 or mall to the <br /> address Indicated abovq, <br /> 2. EHO 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 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 avalloble. <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 aame applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed wlth EHD staff. <br /> 61 Applications received after 3:00 pm will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I <br /> j DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW GATE <br /> <n e� fi aiasro. <br /> TOTAL P.02 <br />