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04/24/2006 10:05 209-579--"125 MODESTO ATC PAGE 02 <br /> EHD LAG NUMBER <br /> SAN dQAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR 2 4 2006 304 East Weber,Avenue,P Floor,Stockton,CA 95202-2708 <br /> ehcl <br /> Telephone: (209)468-3420 Pax:(209)464-0138 Web:www,0j90v <br /> ENVIRONMENT HEALTH <br /> PERM ITISERVIGES PUBLIC RECORDS RELEASE,APPLICA.TION <br /> SUSINESS/AGENCY: <br /> APPUCANT: <br /> ADDRESS3.': 1 <br /> PHONE(Z): FACSIMILE: <br /> PHONE <br /> TENTATIVE*APPOINTMENT DATE: Tom' <br /> (Pissallay 40 bualna=dpYa ffam 0616 of Ic*Ugn submittal.*TwPtadva only-must bs confirmed) <br /> C9 CHECK BOX TO EXPEOrM REQUES 893.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313USINE88 DAYS <br /> SIGNATURE OF APPLICANT r DACE _47A_-_oZ <br /> UNrf DISTRIF3UTION 0 Unk 1 unit 2 UnK 3 0 Un t S <br /> Units Other(allgchgnlC111ub!�r►apa) <br /> FILE ADDRESS EHO USE ONLY <br /> streets Street Name city <br /> 1. ,.•. ff 3 1 <br /> b. <br /> T. �9 <br /> 9. <br /> 10. <br /> Specific Date Range of Infomtation Requested:From BAs ' to C ic"bm <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Uwoewmum TANK(UST)cumuv Sire(LOP) 0 Housmo AeATmocr IQ$OtM WASTE FAcLsrYl fEH1CLe <br /> t]'OTHaR CLeANUP SrM(NON-LOP) 0 Food FACIU iY Cl WASTE TM <br /> 30 UNG TANK(oAonProRfReRtEigoVAL) Q Goo KE RA 0 DAIRY <br /> $WASTE GEnP RRAA1vR l7 GFacNsw RANCH 0 WA$igYYATER TREATMt91r PLANT <br /> TNERED PEFSMtiTER FAC�IlTY M MOTO.M'tOTEL 0 PUMPER TRUC9dy�ARDICHEM Tou s <br /> 0 TATTOO11300Y PWRCINO 0 POOLlSPA 0 L.Amo USE APFtacAnoN SM <br /> R12 MEocAL WASTE FActim 0 OTHER(PLEASE SPEC[ <br /> WELL Amp SEPn1C PC Marr REeoRoa ARE AVAK ARX foot Riv1EW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLuomo HOUDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)94-0138 or mail Ig the address <br /> lndlgkgdsbpvo. Address ranges will not be accepted—for additional assistance wittl file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confinnod <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled sewrdingly. <br /> 3. A file that is actively being worked an by EHD staff may not be immediately available for review, A n$1N <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 expanse of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit pricer to review. <br /> i <br /> END 4!42400 <br /> V14f0i <br />