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2 � MODESTO ATC / PAGE 02 <br /> ©4�11/�©D5 D9:D8 D9-5.c. SCl q j <br /> EHD LOG NUMBER <br /> DATE RECENED SAN JOAQUIN COUNTY Z <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> RR Stockton,CA 95202 , S H <br /> -2708 <br /> "1304 East Weber Avenue, 3d Floor, <br /> Telephone: 209 468-3420 Fax: (209)464-0138 Web: �qX.o eh <br /> Telep ( ) 0Ri"t( I 1 <br /> PUBLIC RECORDS RELEASE APPLI&ITIN <br /> APPLICANT: J"«n Ku+nAcr'+ BUSINESS/A <br /> Y I� I.9�s7>nl:-F,�c ss <br /> ADDRESS: I111 t.0"r Aye5 ,�tA a�cr4o � <br /> PHONE(1): 2-0c? ' $�4 "'2'X I PHONE(2): �•� FACSIMILE: 1 o°t'57'1'Z22f <br /> TENTATIVE'APPOINTMENT DATE: 4 -I -O y Time' <br /> (Please allow 10 business days from date of application submittal-•Tentative 09ly-must S confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-:93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1`�`-�` DATE 4-11-4 <br /> UNIT DISTRIBUTION d Unit 1 t7 Unit 2 ❑Unil 3 O Unit 4 O unit 5 0 Unit e O Other(eiectronicAlstalmaps) <br /> FILE ADDRESS END USE ONLY <br /> Street 0 Street Name city <br /> 1. ISIS S. FreSNo vc_ `^ <br /> S1,ciJv. ? l h -1 <br /> S �kiv <br /> 4. 2005 T c <br /> 54 <br /> 7. ¢1:V4 TII, le.,i;s <br /> e. 111 1V, <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑HOUSING ABATEMENT ❑SOLID WASTE FAcLMIVEHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) p FOOD FACILITY C3WASTE TIRE <br /> OTHER CLEANUP SITE(NON-LOP) 13 <br /> DOG KENNEL C DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) C3 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR O MOTELIHOTEL t7 PUMPER TRUCKIYAROICHEM TOILETS <br /> TIERED PERMITTED FACILITY (7 POOL/SPA O LAND USE APPLICATION SITES <br /> D TATTOOIBOOY PIERCING <br /> MEDICAL WASTE FACILITY 13 OTHER(PLE"E SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY FRIDAY a:00 AM-S:OOPM EXCLUDiND HOLJDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. fax to (2091464-0138 or mall to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled 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 of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 48-024M <br /> V1406 <br />