Laserfiche WebLink
11/10/2003 16:20 209-579-12x25 MODESTO ATC PAGE 01 <br /> ��I�CElJIIt1� �I r <br /> I.rn.Un. <br /> SAN-JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> NOV 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONMENT HEALTH STOCKTON CA 95202 bo <br /> PERkff./SERVICES (209) 466-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �«C�• -- - - - <br /> ff DUSINE551AGENCY <br /> ADDRESS t Lda� a1.M �.it, r.�.'�•c S3 Nlpal�t�4 ifs <br /> PHONE Z` ` �`3 "'L- 'Cl ..FACSIMILr �•� ^'L'L'� I <br /> ' I <br /> TENTATIVE"APPOINTMCNT DATE_ it (L�d3 _ TIME <br /> (PICa.c give 7 to io buZillass days groin date atL4 <br /> applrcatio»5ubititiltal) <br /> l <br /> . . a I <br /> Q CHCGIS ROX TO,EJCr't"f)iTE tit QUEST•387.00 FEE REQUEST PROCESSED IN 3 BUSINESS GAYS Wk` V i <br /> SIGNATURE OF APPLICANT �/��'" � DATE —. it � <br /> I:IL•-AODRESS THIS SIDE EHD STAFF USC ONLY <br /> PROGRAM ELEMENTS SI:ARGH <br /> 'Z'Z 0ti tt t A-4 <br /> b Nsa��� t♦ to g�pLlf� <br /> z 40 <br /> 5. EYa <br /> rd k-'4 •d S4<%ex <br /> --04 43 AM4,..' <br /> y,/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> Vl UNDCRUROUNO TANK LUST)CLEANUP SITU CLOP) O HOUSING ABATEMENT 0 SOLID WAS7e VACILITY <br /> C OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> C UNDERGROUND TANK(MONITORINGIRCMOVAL) ❑ DOG KCNNEL ❑ DAIRY <br /> 0 HAZAROOUS WASTF-GENERATOR ❑ CHiCKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TICRE-D PERMITT;O rACILITY 0 r40TEL1HbTEL ❑ PtIMPtiftTRUCKIYARDICHr-m TOILETS <br /> ❑ TATTOOISODY PSARCING ❑ POOIJSPA ❑ LAND USE APPLICATION SITES <br /> 0 MCDICAL wA5•rI:FACILITY Q PU0LIC WATER 5YS,T11-M 0 OTHER(PLEAS!-SPECIFY Anovq <br /> 1. List up to ton addresses in the span✓ above. Select the type(s) of files from the list above by chocking <br /> the appropriate box(es). At least one file type MUST be Selected. Fax to 209 464-0138 or Ing![ to the <br /> :I[tdr+,ss•indiroted above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be Confirmed <br /> approximately five bG5incSS days but no later than ten (10) days after receipt of application.-The files <br /> will be held for a maxirnum of five business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3- A filo tl)at is actively being worked on by EHD staff May not be irnmediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any fila net I-aturnec, in the same condition as reloaSad will be roorganizod by I:.ho staff at the experlr <br /> of the applicant, Futuro file rovicws by the came applicant may require a$07.00 deposit prior to revlow, <br /> • "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> �. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> - _ <br /> �EVIEWlT(7 YES <br /> �,. .. _ELtel_, NO REVIEW nAT;= <br /> I <br />