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07/30/2093 11:30 2p9-5?9-' ?5 'MODESTO ATC PAGE pl ' <br /> eliI3 Loa NUMBER <br /> DA;rt_REPEtYFD j SAN JOAQIiIN COUNTY •. <br /> - <br /> I I ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 ���3 304 EAST WEBER AVENUE.THIRD FLOOR <br /> JUL <br /> STOCKTON CA 95202 <br /> I (209)468-3420 <br /> ITi,�-1~�'ir. PUBLIC;,RECORDS RELEASE APPLICA1TION <br /> "BUSINESSIAGENCY T sa c7tS <br /> APPLICANTi,.., Kvu �► / <br /> ADDRESS <br /> ilk 1. '.^ I��.Iw, <br /> S <br /> FACSIMILE ' <br /> PHONE , <br /> i r �ctlZ TIME <br /> TENTATIVE*APPOINTMENT GATE <br /> (Please give 7 to 10 business days"M date of applltBtlon su6nirttall L I <br /> . II �T � 1 <br /> TE REQUEST-389. 0 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYSU'A <br /> ❑ CHECK BOX TO EXPEDITE + <br /> DATE <br /> SIGNATURE OF APPLICANT I <br /> THIS SIDE EHD STAFF USE ONLY <br /> FlLEADDRESS <br /> PROGRAM ELEMENTS SIRARCH <br /> r 61 Dt—Je, s+o k <br /> 5,4_ J, Sdvd 4 }iy. <br /> a. <br /> .ENVIRONMENTAL�HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY SOLID WASTE vEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR [3CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS ! <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0.`OTHER(PLEASE SPECK <br /> �. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es).''At least one file type MUST be selected..Fax to 209 464-0138 or tot e <br /> address indicated above. <br /> 2. EHD 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 atter 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 /> 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 ayallable. y <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 same applicant may require a$89.00 deposit prior to review. <br /> S. '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 /> r <br /> CONFIRMED AP-POINTMENT DATE TIME <br /> DATE CQNFiRMED PtidNE FAK INITIALS <br /> REVIEW'0ATE.' <br />