Laserfiche WebLink
MODESTO ATC - PAGE 02 <br /> 12/ 16/ 2003 17 : 54 209 9 -2225 tr+u Gw NVMc <br /> SAN JOAQUIN COUNW " <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - ` 304 E Weber Ave 3"1 Floor Stockton, CA 95205 I <br /> ((209) 468-3420 Faz: (209) 464-0138 Web: VAM'Co.sau joaquin.ca us/ehd <br /> L) Li 20a PUBLIC RECORDS RELEASE APPLICATION <br /> Qc <br /> APPLICAN-6FE �" IM Q,'r1 f� auSINE88lApENCY: 4 <br /> 14 <br /> ADDRESS: L. art e. yG I Yy /* - '! 8 <br /> - <br /> PHONE: 5V FACSIMILE: <br /> TENTATIVE' APPOINTMENT DATE: S.L 6�� Timm: <br /> dr' A'� tlonsubmittel) <br /> (Plasma allow 70 hwlnw drys from ab of PP <br /> CHECK BOX TO EXPEDITE REQUEST • ;03.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Devarbnent use Only <br /> FILE ADDRESS UNIT <br /> mh..r wMy1 OL b Unit 1 � u `i <br /> Z a 3l <br /> / p Unit I, ti <br /> a } L <br /> U1 L <br /> At aw." khit <br /> Cz <br /> a 4 <br /> + 5 <br /> s �.. 5 } <br /> ��_��_ ������;;;; ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT p SOLID <br /> WASTE <br /> VEHICLE <br /> ACILITY <br /> THER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY <br /> NDERGROUND TANK (MONITORINGIREMOVAL) M DOG KENNEL 0 DAIRY <br /> arTL .AR.DOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKO TREATMENT PLANT <br /> ❑ TIERED PERM FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKryARDICHEM TOILETS <br /> 0 TIERED ERM PIERCING (3 POOUSPA Q LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE PIERCING <br /> ❑ OTHER (PLEASE SPECIFY) <br /> e Ilst -boys by chscklnl <br /> 1 . List up to ten addresses In the space above. Select the type(s) of files from th <br /> the appropriate box(es). At least one fila typo MUST be selected. fax to (3091454-138 or mall to the <br /> addre ill notify above. <br /> y, EHD will notify the applicant if any EHD files existM appointment for review will be confirmed <br /> approximately flue 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 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 no <br /> application may be submitted when the Nle is availablem reorganized b EHD staff at the sxpena <br /> 4. Any file not returned In the same condition as released will be Y <br /> of the applicant Future Nle reviews by the same applicant may require a $93.00 deposit prior to rovie' <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> TIME <br /> CONFIRMED APPOINTMENT DATE <br /> , . <br /> DATE CONFI <br /> f7 % <br /> PHONE FAX ' ` . 'INITIALS <br /> REVIEWED YES NO REVIEW DATE. <br /> uw w 4m <br /> I r/Viaaa <br />