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09/01/2004-:° 12'20 .. 209-57Q-''4225 :MODESTO ATC <br /> PAGE X01 <br /> EHO LOQ NUMBI <br /> 1"ll !,10 SAN JOAQUW COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 0 1 2004 304 E Weber Ave 3r'Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: {209}464-0138 Web:www-co.=joaquin.ca.us/ehd <br /> ENVIRONMENT-HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATTDN <br /> APPLICANT:Aks C BUSINESSIA(IENCY: 71 C aCr�rf�s <br /> ADDRESS; Ix , <br /> 41,to <br /> PHONE: - 57-7 - FACSIMILE: - <br /> TENTATIVE'APPOINTMENT DATE- "' �Tams: tm 00 <br /> (Plaaae allow 10 twalnsls days frtmm dale of■pplitavon submlmw) <br /> IM CHECK BOX TO EXPEDITE REQUEST-$93.40 FEE-REC4JESTPR=33ED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT � �� _ DATE <br /> Depadment Lisa Only <br /> FILE ADDRESS UNIT <br /> ,, Adwir i -N` <br /> �4 Q El Unit 1 <br /> x sem, Of _} d� <br /> Unit 2 � 1� <br /> a •u V i tt 1 jar <br /> J. ft" Unit.4 <br /> a erectCW <br /> s. ewsl © Unit 5 <br /> ea. sr.et <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 4PC (fill <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT Jn souD wASTE FACILITY <br /> 10 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY IRi SOLID WASTE VEHICLE <br /> 19 UNDERGROUND TANK(MONiTORINGMMOVAL) 0 DOG KENNEL A DAIRY <br /> 19 HAZARDOUS WASTE GENERATOR 0 cmicKEN RANCH •K pKa TREAT?AENT PLANT <br /> is TIERED PERMED FACILITY• C] MOTELIHOTEL RI PUIIRPER TRUCKJYARDICHEM TOILETS <br /> C] TATTOOIBODY PIERCING 0 POOLISPA It LAND USE APPLICATION SITES <br /> f3 MEDICAL WASTE FACILITY It OTHER(PLEASE$PEC}F1ff._r�Pn"we4�/t� <br /> 1. List up to ten addresses in the space above.-Select the type(e)of fifes from the list above by Checking <br /> the appropriate box(es). At least one file"MUST be selected. Fax o <br /> %ddress;Indicated above. <br /> 2. EHD will notify the applicant if any EHD filen exist.'An Appointment for review will be confirmed <br /> approximately five business days but no later then ten(10)days after racelpt of appllcation. 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 nev <br /> application may he subniltted when the file is available. <br /> 4. Any file nqt 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$93.00 deposit prior to reviev <br /> 5. "TENTATIVE appointment dates must be confirmed with EHO staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> �� TIME <br /> _":,�.;:.�•.,�.. ;,,, :.�.:�. •��. _ _:,: <br /> -CON"'F RM ED AtsPeSiiV <br /> M 1JIa��- <br /> . PRONE <br /> DACE C( NFIt7% <br /> Mi=d <br /> REVIEWED :.YES NO REVIEW DATE, <br /> i <br />