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11/10/21300 12:42 209-57c ?25 MODESTO ATC PAGE 02 <br /> TO 5?522c5 P-OL <br /> FRO] _ ..,� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> NOV 10 2000 ENVIRONMENTAL HEALTH DIVISION <br /> 3o4 EAST WEBER AVENUE,THIRD FLOOR t <br /> ENVIRONMENT HEALTH STOCKTON CA 0202 <br /> PERMfTISER ES (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 18USINESSIAGENCY SUGI� <br /> AdDR.ts99 r'f S~}Q{� ��L�1 <br /> FACSIMILE <br /> N lVE*APPOINTMENT DATE—.VJQ-4 �(` K — TIME <br /> f ptaa"9Iw 7 to 10 business days tram Qa1e of apvlicaticn submittal) <br /> HECK BOx-To EXPEDITE REQUEST.378.00 FL -REQUEST.P 4C633ED IN 3 BUSINESS DAY$ -, <br /> - ` DATE (,L(10C i <br /> siGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> �. �• �. ✓}+./ Q 'FU t ILS"� �=7.� �- Jl <br /> �t�C7 LtJ. C.lAo. C\-k r <br /> 1'-(-z(. c 1 S rt,rt tF,y rc io-t �z�.d s <br /> i'F4'4 S.� s��-, �.olh t S kf4 �-4 <br /> IS tri o CLMk\ W 1. 5 YJ ' 3 Zt=' <br /> I <br /> ENVIRONMENTAL HEALTH OIVMION FILES <br /> UNDERGRotJNP TANK(UST)CLEANUP SITE(L.OP) C HOUSING ADATEMENT t3 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LQP) ❑ FOOD FACILITY Q SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND T^NK(MCWTORM04LEMOVAL.) 0 POU KENNEL Q DAIRY <br /> O HAZARDOUS WASYE OltNERATOR ❑ CHICKEN RANCH 0 PKG TRIYATMENT PLANT <br /> ,.!I T1ERCO PERMrrT90 FACILITY d MOTELlNOTEL O PUMPER TRUCt(fYAFtpjtrHEIVI TOILETS <br /> * TATT001500Y PEIRCINO 0 POCUSPA © LAND U3EAPPUCATION SITES <br /> * MEDICAL WASTE FACILITY CI PUBLIC WATER SYSTEM In OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(3) of files from the list above by checking <br /> the appropriate box(es). At least one Me type MUST be selected. E;x to(2Q91 464.0138 or mail to the <br /> address indicated apgvq <br /> 2. EH0 will notify the applicant if any EMD tiles 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 live business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3, A filo 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 <br /> of the applicant. Future file reviews by the same applicant may require a$78.04 deposit prior to review. <br /> 5. "TENTATIVE= appointment dates must be confirMod with EHD staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME �. <br /> DAT E CONFIRMED PHONE FAX 1Nrr 1A15 <br /> REVIEWED YES NO REVIEW DATE <br /> t4+ 04 f4– <br /> TOTAL P•e2 <br />