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09/03/ OQ 209-579-2225 MODESTO ATC PAGE 01 <br /> ; 1_I(_= END BOO NUTAeER <br /> SAN JOAQUIN COUNTY <br /> SEP 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> WMONNIENT HEALTH STOCKTON CA 95202 <br /> PFT)'[%IIT,SERV!CES (209) 468-0420 <br /> PUBLIC RECORDS RELEASE{,APPLICATION <br /> APPLICANT re Ar /`r�`�^� BUSINESS/AGENCY /i 1c <br /> ADDRESS <br /> PHONE �"ZLL _FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE— -?� `1(W<:-'3 TIME cll� <br /> (Please give)to 10 business days from date of appllcatlon submittal) • <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 F E-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> k0l <br /> / l Hili) <br /> l JAc <br /> SIGNATURE OF APPLICANT 0 � C ,J�-J�1`- DATE `t 5 4z� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Z 35 <br /> L <br /> Lna <br /> d Mo.wk�, <br /> Leo <br /> 44 <br /> �/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> t�4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> a OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OMER(PLEASE SPECIFY) <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) 464-0138 or mall to the <br /> address Indicated abpve. <br /> 2. 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$89.00 deposit prior to review. <br /> 5. '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 /> Ct7t Ft ¢1V li" PC�Iti r t r�?r 6ATE <br /> DA-T-9 E3ONFtRM110. PHONE INITIALS <br /> RE.VIAVVED YES NO W, E <br /> EHD 48-02.008 <br /> IVM2003 �) �, j. (�' F�it� -cC� cvlr6�.-rye ud >-r'-�;LS - urn ( v _, � . <br />