Laserfiche WebLink
MODESTO ATC PAGE 01 _ <br /> 09/11/2002 16:07 209-q79-2225 • <br /> at <br /> o ��li'\ L� U� = 11` JA!112 2 <br /> IN COUNTYPUBLIC HEALTH SERVICES FEEL �rI �� E D <br /> ����� ENVIRONMENTAL HEALTH DIVISION L� Lit Lv <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 12 2002 STOCKTON CA 95202 SEP 1 2 2002 <br /> (209) 4611-3420 <br /> MENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> APPLICANTMI Q BUSINESSIAGENCY p �c�- <br /> ADDRESS ��,• <br /> PHONE • 'J — �1FACSIMILE <br /> TENTATIVE'APPOINTMENT DATr -/ / 4�1� TIME IU--� <br /> (Plcane Divo 7 to 10 businoss da fro' o o0ap, Icallon a'I)1111 l)CHECKBOXTO,EXPEDITE REQUEST- 7.c -QU ROC• SEDBV51NE$S DAYS <br /> SIGNATURE OF X4PLICANT DATE S' h CrV <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Q}ter 2sG f <br /> 1 5 <br /> 10 <br /> rk n )14 <br /> C� G <br /> 13 F o <br /> O 6" <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> O-UNDERGROUND TANK LUST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON•LOP) • ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTC GENCRATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIEREDPERMITTDFACIUTY ❑ MOTEQKoTEL 13 PUMPER TRUCWYARDICHEMTOILETS <br /> ❑ TATTOO18ODY PJACING ❑ POOLISPA " ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WAS 11 FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. 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 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 bo 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 now <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 $87.00 deposit prior to review. <br /> 5. '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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED+ YES NO REVIEW DATE <br /> RO�� . . <br />