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08/16/2002 11:44 2097-79-2225 MODESTO ATC PAGE 01 <br /> SAN'J O <br /> AQUiN COUNTYPUBLIC HEgLTI-f SERVICES <br /> ENVIRONMENTAL, HEALTH DIVISION l ��] <br /> 304 FAST WE13ER AVENUE,THIRD FLOOR l! ll �D <br /> STOCKTON CA 95202 <br /> (205)4611-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AUG 18 2002 <br /> APPLICANTL7. d tw Q&"e �1k t�, BUSINESSIAGCNCY ���- -tt a��4�,4 ENVI H <br /> ADDRESS L l[�- Leta na fAvvv M S 35�( ICES <br /> �tA►..1�.�.r-t. Sa,� � -�ef�s� <br /> PHONE ZO9 }1 T ZZ'L 1 FACSIMILE Z.%!19 -4-1 <br /> TENTATIVE'APPOINTMENT DATE ((Z-40 TIME �G� <br /> (!'Icasp D"SL7 lob ffo c of gotlon;vbinittoi) <br /> CHEC' BOX TOXXPEDITI;REQUEST-$07.00 F E- <br /> REQUESTARa TD ISI ^s BUSINESS GAYS <br /> SIGNATURE OF APPLICANT � DATE —`alIV'I-Q.Z <br /> i <br /> FILE ADDRESS T1413 SIDE CHD STAFF USE,ONLY <br /> { PROGRAM EL1rMCNTS SEARCH <br /> S ,awn .T+i'ac Q t.) 54gtK�on o o I <br /> 5"5r y�tr��a octal SkoCkah m o u <br /> LAO i'7, W t> oS�an:at 1Rw,�►.lt N1acc �o <br /> � t4 4l' ��,l0. t3 Z ,mol:$ • ;� <br /> s+�+ <br /> 1►1R3f G<wGr r calci cr{oJ1 0 <br /> q'( <br /> ZE`i 1 tk <br /> �'S Ea 11-'A ►wt. "7 V q'- <br /> 15 <br /> Eli4a� <br /> SSI RSI- t_�4R1� Vt,A.►C ��� d <br /> ENVIRONMENTAL,HEALTH DIVISION FILES <br /> UNDERGROUND YANK(UST)CLF.ANVP SITE(LOP) O HOUSING ABATEMENT ❑ SOUD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACdJTY 0 SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORLNGIRL-MOVAL) 0 DOG KENNEL p DAJRY <br /> C3 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 4 PKG TREATMENT PLANT <br /> O TIERED PERMITTgo FACILETY ❑ MOTEIIHbTEL 4 PUMPER TRUCKIYARDICHEM TOILETS <br /> 7ATTOOlJSODY PEIIItCtMG ❑ POOIJSPA Q LAND USE:APPLICATION SITES <br /> ❑ MEDICAL WASTI!FAC1t.ITY ❑ Puowc wATER SYSTEM 0 OTHER(PLCASE SPCCIFY.ADOVQ <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the Iist above by checking <br /> the appropriate box(es). At least one filo type MUST be selected. Fax to 12 09) 464-0138 or mail to the I <br /> address in icated ab v <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 tan(10)days after receipt of application.-The files <br /> will be hF4d 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 raturnod in the same condition as released will be reorganized by EHD staff at the expanse <br /> Of the appilcant. Futuro filo reviews by the same applicant may require a 5117.00 deposit prior to roview. <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 /> CONFIRMED ApppINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> Rl:ViE-WED . <br /> Ella u e roe YES NO REVIEW DATE <br />