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04/25/2000 12: 42 209-570-0225 MODESTO ATC PAGE 02 <br /> t�3��71-2L3�Ji3 �9 aF�i i FRt� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 FAST WEBER AVENUE,TH RD FLOOR <br /> STOCK-TON CA S$202 <br /> (209)458-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> xPPLICANT BUSINESSfAGPNGY <br /> r �vin , S,3.� <br /> Ary0RtE9S ��l�' �D�' I <br /> PHONE s'�.� ��^_ z-z l FACSIMILE I�t]V Q�1l1 <br /> aC ! 2- <br /> TIME <br /> TENTATIVE'APPONPw v7 1010i�aYN°^'dau of a¢PUcston submittal) -- <br /> �RrCkTECK 80X TO EXPEDITE REQUEST-$78.00 FEE-RE_g0EST Pita 1: S D IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE AneRfESS <br /> C i <br /> 5L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )eUNDIIRGROUND TA14K JUST)CLEAMP SITE(LOP) a HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> C7 O'r1,46R CLEANUP SITE(NON-LOP) O FOOD FACILITY M SOLID WASTE VEHICLE <br /> >(UNDERGROUND TANK(NIONIYORINGMEMOVAL) 0 DOG KENNET. ❑ DAIRY <br /> 0 HAZARDOUS WASTE d[NCRATOR O CHICKEN RANCH 0 PKG TREATMEW PLANT <br /> 0 TIERED PERmrITED FACILITY 0 MOTELIHOTEL O PUMP>r!1 TRUCKIYAR=HEM TOILETS <br /> 0 TATTOO/600Y PEIRCING 0 POWSPA O LAND USE APPUCAYION SITES <br /> C! MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM M OTHER(PL.F?-ASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the apace above. Select the type(s) of tiles from the fist above t)y Checking <br /> the appropriate box(ea). At least one fila"a MUST be seiected. Fax to(2221,464-013 r mail to thle <br /> address itldiratedabgVQ, <br /> 2. END 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 hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worsted vn by EHD staff may not be immediately available for review. A new <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 $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 61 Applications received after 3.00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DAT E CONFIRMED RHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Eh oa otasoa <br /> TOTRI, P.0� <br />