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10 / 04 / 2002 11 : 12 209 - 579 -2225 MODESTO ATC PAGE 01 <br />( SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 1OX0 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> A0020 <br /> STOCKTON CA 85202 <br /> D200) 468-3420 <br /> PUBLIC RECORDS S RELEASE <br /> APPLICATION <br /> ON <br /> APPLICANT Jlwl nUNjBrt BUSINESSIAGENCY _ H I G_. 4o F.Jer IR -� `` -� 1. - _L. 5 <br /> ADDRESS <br /> rr�I II ( 7 LOW P 1I a 14e Tj htoa/e {� C <br /> OcT <br /> PHONE _ �lOZf � S 9- 2221 t/Zoot S?/ - .22.ZS <br /> FACSIMILE' _ <br /> TENTATIVE' APPOINTMENT DATL ICJ ' xl — UZP r V L TH <br /> (Plaasa Bi a 7 to 10 Uusinas- TIME _ / �ry PERMIT/SERVICES <br /> ys Ir dale o ppllea Uon zl Hlal) <br /> CHECK BOX TO, EXPEDITE REQUEST • O FE, REQ J STP SE N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> p DATE /U- U Z <br /> FILE ADDRESS THIS SIDE 6HD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> AL M44et <br /> »d Greer � 15 5 'ne vl Q:d S. Es n <br /> o f+» s 5f5g 5e�f ;� v S e k ✓ <br /> B 't SAC Se i 2353 T� h <br /> SC 7 <br /> B <br /> fw r✓ 5 O Tvo.c T �. <br /> � I 1 v1 235ca ws vl (� Tva <br /> TrqC <br /> RIM 3 350Tko , au S. Tv,. <br /> lo, ir Yv�ki» 3�flrJ G;,, <br /> Yr Ivv M we r, s. T <br /> ' a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY - ❑ <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ SOLID WASTE VEHICLE <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH _ ❑ DAIRY <br /> ❑ TIERED PERMITTUr,D FACILITY ❑ CHICKENMOTLLIHRAN PKG TREATMENT PLANT <br /> ❑ TATTOOIBODY PdIRCING ❑ PUMPER TRUCWYARDICHEM TOILETS <br /> ❑ MEDICAL WASTE= FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ PUDLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ADOVEI <br /> 1 • List up to ,ten 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 (209) 464l­0138 or m lil to the <br /> address indicated above <br /> z• EHD 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 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 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 $ 07.00 deposit prior to review. <br /> 5 . "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 04 Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YES NO <br /> iH oo a maim REVIEW DATF - <br />