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W ,� I � 11710 / 2003 16) : 20 209-579-2925 - MODESTO ATC PAGE - 01 - <br /> n� SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> NOV 1 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENT HEALTH 304 EAST WEBER AVENUE, THIRD FLOOR bo <br /> PERN41T/SERVICES STOCKTON CA 95202 <br /> (209) 468-3420 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT C2+"1 2' A��e ousINESS/AGENCY <br /> AODRESS I Leu+l v\h.M A%.lt , Sa%Urt D rev 4�liTu <br /> PHONE L"oR S 'i* — Z.Z-Zl FACSIMILE <br /> TENTATIVE^ APPOINTMENT DATE �� ( O3 TIME <br /> (P'"a Q Give 7 to 19 bu5inoss 00ys from data o( applicat)oo �W+tf))Ilil) <br /> CHECK OQX TO,G(PEDITE REQUEST - $07.00 FEC, r REQUEST PROCCSSED IN 3 aUSINESS DAYS �\ • 1 � . <br /> SIGNATURE OF APPLICANT DATE _- 11 � <br /> FILE ADORE=5S - THIS SIDE EHD STAFF USE. ONLY <br /> PROGRAM CLEMCNTS SEARCH <br /> qZ at.t .t , t,�vt ${paJL <br /> � H� ���. t ♦ 10 gi�t)t <br /> zoo s . E L '.?a r.Jo s4,r�+E Frerv.� ca T <br /> flI 5 .Dbr.da 5 {��tcbr <br /> kHo5 0 �: iL N+It n.tt klan <br /> �o Lw1 .t � �d Seo GK n <br /> ,5 4n <br /> �Li <br /> o <br /> ' a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> N UNDERGROUND TANK (UST) CLEANUP SITE CLOP) q HOUSING ADATEMLNT O SOLID WASTE PAGIUTY <br /> ❑ OTHER CLEANUP SITE (NON•LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VCHICLE <br /> ❑ UNDERGROUND TANK (MONITORING(RCMOVAL) ❑ DOG KENNEL q DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PRO TREATMENT PLANT <br /> ❑ TIERCD PERMITT;0 FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCIOTARD/CHEM TOILETS <br /> ❑ TATTOOISODY PUIRCING ❑ POOUSPA ❑ LAND USE APPLICATION Sn'ES <br /> ❑ MEDICAL WAS'(L FACILITYO PUDLIC WATER SY5.TL"M ❑ OTHER (PLEASE SPECIFY ADOVE) <br /> 1 . List up to ten addressoS in t11e space above. Salect the type(s) of files from tite list above by checking <br /> tfie 4pprdpr)ate box(es) , At )cast one file type MUST be seloeted. Fax 10 209 464-0130 or mail to the <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 after receipt of application. The files <br /> will be held for a maximum Of five business days for review, Appointments should ba scheduled . <br /> accordingly. <br /> 3 - A file that IS actively being workod on by eHD staff may not be immediately available for review. A now <br /> Application may be submitted when the file is available, <br /> 4 • Any file net returned in the same condition as relcasod will be reorganized by EHD staff at the expense <br /> Of the applicant, Future file reviews by thQ same applicant may require a $87.00 deposit prior to review, <br /> 51 "TENTATIVE appointment dat.65 must be confirmed with EHD staff. <br /> 6 . Applications received after 3 ; 00 pm will he processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE <br /> FAX INITIALS <br /> REVIEWED <br /> _._. NO REVIcW r) ATP <br /> �o <br />