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12/16/2003 17:54 2E ;79-2225 MODESTO A- PAGE2 <br /> 0 <br /> ��y�vW <br /> SAN JOAQUIN COUNT'S triV LVV NUML <br /> ENvIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3''Floor Stockton, CA 95205 J <br /> 1 ' X06709)468-3420 Fax: (209)4640138 Web: www.co.san-jouquin.ca-us/ehd <br /> '1PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -_ /1 I t`�l(1 n_ A BUs(NE89/A¢ENCY: QG <br /> ADOREss: CL an e- G rr, f� �^Q -9 ~ <br /> PHONE: FACSIMILE:�`�- <br /> TENTATIVE'APPOINTMENT DATE: 6r-)3 Ti.: <br /> (Plea.allow 10 bualn.sa days from aU of Qp cation submittan <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Departrnont Use Only <br /> FILE ADDRESS UNIT <br /> A J 64, Unit 1 <br /> 2- �-u <br /> 1 , , d L -3 / U ❑ Unit 2 � <br /> 4, Dinh } Y <br /> Unit 3 JJJ <br /> a <br /> �. 9VeM <br /> a Unit 4 <br /> a str.� 1Za } <br /> 97 <br /> n it <br /> 5 <br /> ..� '5t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLlD WASTE FACILITY <br /> HER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> DERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL DAIRY <br /> ia'HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH E3 PKQ TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 171 PUMPER TRUCKNARD/CHEM TOI>rET8 <br /> 0 TATTOO/BODY PIERCING CI POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list aboye by checklm <br /> the appropriate box(es). At least one file type MUST be selected. oto (399)404-0134-or maLl ULft <br /> adEigj Ij]0Syt <br /> 2. EMD will notify the applicant N 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 appllcatlon. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3, A file that Is actively being worked on by EHD staff may not be immediately available for review. A ne <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 expens <br /> of the applicant_ Future file reviews by the same applicant may require a$93.00 deposit prior to revie, . <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> TIME <br /> CONFIRMED APPOINTMENT DATE - <br /> DATE CONFIRMED PHONE FAX' ``' '` .�:�`'M)'(ITU!cC.$ <br /> .. REVIEW DATE. <br /> REVIEWED �- XES NO <br /> �0 4a.azaas <br /> ervsoa� <br />