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U9/0112004 .12:41 ZU9-579-2225 MODESTO ATC PAGE U1. <br /> EHD LOO NUMB <br /> FbDATE RECEIVED ` SAIN JOA' QUIN COUNTY <br /> Iii iL (�L _ ,�(�� ENVIIraN1Y�N�rA�REALTx DEPA TNITNT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> $E P 0 1 2004 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.co,san-joaquin.caus/ehd I� <br /> L vVIB,AMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PE ' S �l�G€c <br /> APPLICANT: ®('LW �a'N Mt- BUSINESSIAGENCY: / TTC' <br /> ADDREss: ll1'� t_��e. �41� A-,p4L 5��1-� �, MocaoSlo <br /> PHONE: Z, S7'-J-A - 7 Z"t-1FACSIMILE( 1.'O1. 5' -f--7 - ZLtr G <br /> TENTATIVE"APPOINTMENT DATE: 'I I P�jf>L Time: C) I aQ <br /> (Please allow 10 business days from date of application submittal) <br /> 12 CHECK SOX 70 EXPEDITE REQUEST-SHI.0101FEE-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 7 v` DATE <br /> �JdTE�. o kj LCA Riles r S: S (�++aUM (`h%YIL15�(FtLTJ woetruantUse Only <br /> FILE ADDRESS UNIT <br /> SaA m sv.. 5`taf� PCtL LLCK tiU t iAZ �� <br /> z s,a�r 51 SI acs C --A. rt C3 Unit 1 <br /> 3Sa�Tr! 9. 9ne[ Co �4 .t A04"--It- y C] Unit2 <br /> �' S i 2 <br /> 3 5�7 V <br /> 35x7 3 W. C1ti�r a S� CCvk-c Uni <br /> 35aEr' a. ay..r - -57.30 N. l>JfSa- tk% yL S Lk <br /> 35a-` �er l4l°t zi-, 1 5 �' ❑ Unit <br /> 5�'7 0. sveeL / Si(,Y dqtV6. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> t2 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY in SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> iV HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKO TREATMENT PLANT <br /> 11 TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL G PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING C POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY CI OTHER(PLEASE SPECIFY) <br /> 1, List up to ton 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 (R09) 484-0138 or mall to the <br /> address Indicated 09va. <br /> 2. EHD will notify the applicant If any EHD riles exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tan (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 net <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 expenai <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> S. '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 /> awe-0a <br /> �erinal <br />