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04/11/2005 09:08 209-57 `225 MODESTO ATC _ PAGE 02 <br /> EHD LOG NLNBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL M <br /> �HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3 Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web: o eh <br /> PUBLIC RECORDS RELEASE APPLI,C&T N,,,,, <br /> Y IJP HJ �lfcs <br /> APPLICANT: _BUSINESSIAVT1�1fiENT'-- <br /> ADDRESS itl,+ Loti iPdo.. Ave 5 4e ede a C <br /> FACSIMILE: Log-574•Z22 f <br /> PHONE(1)_ 2.ocr - 6'4,q . 1?2•I PHONE(2): <br /> TENTATIVE'APPOM HENT DATE: 4-t v-O 5 Time: <br /> (Plesso allow 10 business days from data of APPlicatlon submittal-*Tentative only-must bs--flrmod) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSna"DAYS <br /> SIGNATURE OF APPLICANT `/ '"� DATE 4_O_vf <br /> UNIT DISTRIBUTION In Unit 1 0 Unit 2 0 Unit 3 0 Unit 4 0 Unit 5 13 Unit 6 O Other(o CAlatc*=Ps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 3 a Name City <br /> 1. sis S. FrasMO '^ <br /> 2. l4 W. Cl,cv W, S4.cfc,l.a <br /> 3• tilt S• ►.o S rtc 4= <br /> s , „ '*5 C-) 1 <br /> 4. 200S r.vt Q bVIA f <br /> 5. del ri Sj,.4�e�. <br /> 6. 59 D /! <br /> 7. <br /> Alw <br /> 10. <br /> Specific Date Range of Information Roquestod:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOW WASTE FACILIYNEHK:LE <br /> OTHER CLEANUP SITE(Nou4LOP) E3 FOOD FACILITY O WASTE TIRE <br /> I bMROROUND TANK(MowroRRIO/REgOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZAROOUS WASTE GENERATOR O CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 IdoTELIHOTEt 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOi PERMITTED <br /> ODY TEDPIEFACILITY <br /> f7 POOLISPA 0 LAND USE APPLICATION SITES <br /> NG <br /> O 14EDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY•FRIDAY&:00 AM-S:0OPM - E%CLUDWG NO WAYS. <br /> 1. List up to ten addresses in the apace above. Select the type(s)of files from the list above by checking the <br /> appropriate box(ea). At least one file type MUST be selected. fax to(209)464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted-for additional assistance with 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 H any EHD files exist. An appointment for review will be confirmed <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 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 END staff at the expense of the <br /> applicant. Future file reviews by tho same applicant may require a$93.00 deposit prior to review. <br /> EHD eaa2-M <br /> w,uos <br />