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07/13/2005 09:06 209-579-2225 MODESTO ATC PAGE 02 <br /> DATE RECEIVED SAN dOE1ip LOG NUM81 <br /> ��Q�Jnv COUNTY <br /> ENVIRONNIMNTj LL 1B1ALTH DEPARTMENT <br /> 304 EWeber Ave 3r°Floor Stockton,CA 95205 <br /> JUL r 3 M 468-3420 Fax: (209)464-0138 Nkeb, www.co.san-joaquincaus/ehd 1, ? 7R0 <br /> LN� 1 Gn4� <br /> IRONMENT HEALTH PUBLIC RECORDS RELEASE APPIACA 11ON � <br /> APPLICANT: O ��BU i1 ESS/AGENCY: L l <br /> ADDRESS- I�i� L erg, P� ► `( p <br /> PHONE: C2 I 7 q - �. --2- 1 FACS MILE: ! ZZZ <br /> TENTATIVE*APPOINTMENT DATE:—--I - Z G' O TIM, J ' <br /> (Please allow 10 buainem i days 'rom date of applicatlon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REC VEST 2ROCESSED IN 3 BUSINESS DAYS <br /> 1 <br /> SIGNATURE OF APPLICANT �y DATE <br /> Department Use only <br /> FILE ADDRESS UNIT <br /> `ti . 14 1 a I�1 <br /> sheet ^ an ❑ Unit 1 <br /> 4. sb*e ❑ Unit 2 Q <br /> a Unit 3 <br /> a <br /> 7. west ON <br /> "'OUnlf 4 <br /> e. -- C ❑ Unit 5 <br /> ca <br /> 40. Strmet <br /> ENVIRONMENTAL HEAI.TH DEPARTMENT PILES <br /> UNDERGROUND TANK(UST)CLEANUP SrM(LOP) = HO!SING ABATEMENT ❑ SOLID WASTE FACILITY <br /> k!"QTHER CLEANUP SITE(NON-LOP) Cl FO 3D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) n 00`a KEN DIEL ❑ DAIRY <br /> e'HAZARDOUS WASTE GENERATOR ❑ CH CKEN RANCH ❑ PKQ TREATMENT PLANT <br /> 12-TIERED PE4 MrrrED FACT{l ry ❑ Ma rEL/HoTFL 10 PUMPER TRUCKIYARD/GHF-A TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ PO X/SPit 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTI IER(P JFASE SPECIFY) <br /> 1. List up to ten addresses In the space abo re, $alect the type(s)of fifes from the list aboye by checking <br /> the appropriate box(es). At least one file!ype MUST be selected. Fax to(209)484-0138 or mail t9 thq <br /> address Indic1ted above. <br /> 2. EHD will notify the applicant If any EHD fi'as exist. An appointment for review will be confirmed <br /> approximately five business days but no I Mer t Ian ten (10)days after receipt of application, The flies <br /> will be held for a maximum of five busine:4 da3v for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by I'HD ataff may not be Immediately avallable for review. A new <br /> applicatlon may be submitted when the fli l Is a mllable. <br /> 4. Any file not returned In the same conditio i as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th,i same applicant may require a $93.00 deposit prior to review. <br /> §, *TENTATIVE appointment dates must be t onfinned with EHD staff. <br /> 61 Applications received after 3:00 pm will bi processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX ANITLALS . <br /> REVIEWED ,. YES NO REVIEW DATE <br /> 4-0oe <br /> uaaoma <br />