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09/19/2002 16:03 20 :79-2225. . MODESTO AT PAGE F <br /> I! SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ",..,,,•,.,�,..�� �� <br /> ENVIRONMENTAL HEALTH DIV1S10N <br /> 304 EAST WES R AVENUE,THIRD FLOOR D -� <br /> 100 STOCKTON CA 25202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION SEE19 ,20OZ <br /> APPLICANT <br /> I BUSIt4[55rAGENCY ENT HEAL�bi <br /> ADDRESS III7 Lore&8ALjA '' IT�S> R <br /> .4 V r Q /U1Q�aS <br /> PHONE / 15 FACSIMILES 5 7!2 i 7-5 <br /> TENTATIVE"APPOINTM[NT PATI:— /Qf TI1 TI E_ Q i AA <br /> (PIOASO Hive 7 to 10 burin .mac• 5 days Ir alp Q!sppl' ado' n suuinit131) <br /> �>��CHECK 130X TO,EJ(PEDRE REgUt:$T E- G UE RO D 1N t1U51N>;55 DAYS J <br /> SIGNATURE OF APPLICANT DATE 49 /9 2r <br /> FILE ADDRESS THIS SIDE END STAFF Us&-ONLYi <br /> 'PRQGRAM ELEMENTS SEAAGH <br /> IV <br /> l <br /> T Z u <br /> FAQ I <br /> L,op <br /> " ENVIRONMENTAL HEALTH DIVISIQN HUES <br /> VI'IDERGFtOVND TANK(US n CLEANUP SITE(LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FAC1LrrY 13 souD WASTE VEHICLE <br /> UNOCRGROUND YANK(MONITORtNGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> mA7ARDOUS WASTE GENERATOR " 0 CHICKUN RANCH 0 PRG TREATMRNY PLANT <br /> 0 TIERED PERMITTCU FACILITY ❑ MOTEUHOTEt. 0 PUMPER TRUCKITARDICHENi TOILETS <br /> 0 TATTOOIBODY P91RCING ❑ POOLISPA 0 LANE)USE APPLICATION SITES <br /> 0 MEOICAL WASTE FACIuTY 0 PUDL.IG WATER SYSTEM 01 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select tho type(s) pf files from the list above by chocking <br /> the appropriate box(es), At least one filo type MUST be selected. Fax to 209 464-0'i38 pr mail to the <br /> address'indicatGd above. <br /> 2. EHD will notify tho applicant if any EHO files exist. An appointment for review will be confirmed <br /> approximately five business clays but no later than tbn (10) day$after receipt of application.The files <br /> will be held for a maximum of five business clays for review. Appointments should be scheduled <br /> accordingly. ; I <br /> 3. A file that is actively being worked on by EHD staff may not be )mmediately available forreview. A new <br /> application may be submittcd When the file is available. <br /> 4. Any fllc not returned in the same condition as released will be rcorganizad by EHD staff at the axpenzo <br /> of the applicant. Futurc file reviews by the samo applicant may raqu,rc a$07.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> 6. <br /> Applications received after 3:00 pm will be processed the next business day. r <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW OATI+ <br />