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05/14/2003 10:01 209-579-2025 MODESTO ATC PAGE al <br /> owa aeceNap rM too rween <br /> " SAN JOAQUIN COUNTY <br /> MAY 1 1 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR /s I <br /> STOCKTON CA 95202 �(1/ <br /> (208)488-3420 <br /> f� <br /> PUBLIC RECORDS RELEASE APPLIC.NTION <br /> APPLICANT D(,t.v./ 0'. Ar\\Q_^ BUSINESS)AGENCY Arc�,_'�,•:-sL•�®_�_® <br /> ADo1TEsa I \1� Lost Pct\.�, A.re,n.rl S�•+e $ . .M-sr9.Es4o .__.� <br /> PHONE Z%a'9 5''+ – ZZZ t FAC.`tMRA' ZtM`T S'?jcT – <br /> TENTATIVE*APpowTLEENT DATE .0 z-*(o.I TIME I0C"C3 X31 <br /> (Weare give T to 10 bualnsss d"fnxn cats of application suhm-tial) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$08.00 FE –REQUEST PROCESSED IN 3 BUSINESS'DAYS r A <br /> SIGNATURE OF APPLICANT D�/�"� �o`^ '`I'"� DATE <br /> FILE ADDRESS THIS SIDE:EHI: STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCII <br /> ( + S—,. -\n <br /> - 533 ro\4-c, bod incl <br /> u�� Mo of lva McaLa _� <br /> 2'3V3v . 132 cr .\:s L 0arab -- <br /> 51 C•n.,^t C(,c (ilvd. Si-OCK(o.� �i,�� <br /> 9 E Z� S(o .kin _ —� - <br /> Sofl <br /> 'i Mac<do lt. S-F..-ate+ 1-c�l�,Np — <br /> a(e M rtL lt. P,ti4e --- <br /> uu �_ c}.^+ort. S+-,+�+, o-.pec• <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> lay UNDERGROUND TANK(UST)cLEIWUP SITE(LOP) ❑ HOUSUK;ABATEMENT ❑ SOLID W*TE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON4,0p) ❑ FOOD FACILITY ❑ 1*1.10 INkSTF VEHICLE <br /> ❑ UNDERGROUND TANK(MONLTORINGIREMOVAL) ❑ DOG KrNNEL ❑ LIAIIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKL:N RANCH ❑ P01 TRE ATMENR PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELNOTEL ❑ PUMPER TRUCIrJYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCINO 4 POOLJSPA ❑ LAND U9 E APPL.ICATKM:SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) __^__—" <br /> T. List up to ton addresses in the space above. Select the type(s)of file/,ft om�:he Hat above by checking <br /> the appropriate tlox(tm). At least one filo typ,I MUST be selected. EM.tq,=1L4a4,-0138 or mall to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for revlo ry will be confirmed <br /> approximately five business days but no later than ten (10) days after refaolp.of application. The fllos <br /> will be held for a maximum of five business days for review. Appointments I:hould be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHO staff may not be immediately uvalBable for review. A new <br /> application may be submitted when the file hi available. <br /> 4. Any file not returned In the same condition as released will be reorgarllvid b r EHD staff at the expanse <br /> of the applicant. Future file reviews by the same applicant may mqulnt r $89.00 dinpoalt prior to review. <br /> b. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next buslnells day. <br /> CONFIT APPOINTmr;NT DATE Ttt*x <br /> DATE OOOiFNWED PHONE FAX INITIALli <br /> REVIWMW YES NO RZWf VgA'i<E: <br /> Y2V2C01 <br />