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U'J/61/2bb4 ..12:41 . . 2U9-579-2225 MODESTO A PAGE. U1 <br /> DATE RECEIVED EHO LOG NUMBE <br /> F�o{��,,, SAN JoAQunv Courrr <br /> IR L��L 1�LQ IUJ ENVIRONNSENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 Iq SEP 0 1 2004 (209) 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd ]V�7 <br /> UAR,]i'dfd1ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ()f`(W ``�Ckv% Ot" BUSINESSAGENCY: AT <br /> ADDRESS: (t1-� L,,,,,AP- SQ Q Mo�Sb <br /> PHONE: Z� R S71-$t 7-7-'-1 FACSIMIL : Z",o'll. S' T-9 - ZZ-T-r <br /> TENTATIVE'APPOINTMENT DATE: I t d( Time-. 0 9 x 0 <br /> (Please allow 10 business days from data of appllcatlon submittal) <br /> In CHECK BOX TO EXPEDITE REQUEST-$93.00,FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT b j'�""1V7``-/ll''/k DATE <br /> RtW ✓ si S FiwYat�h l�%i1U5f�Kzt�t oeoaranentuseonly <br /> FILE ADDRESS UNIT <br /> 35a mz sSmtreet 5`tAd ❑ <br /> Unit <br /> 51^I 4Lt lL ��t a <br /> /„r•�/1_Q <br /> %jLIL-re. Y $�LK •n' S [] Unit <br /> 3520 M .. sreet �dt\ ll tavl <br /> Lo L k. Pio.+ S{-r $ CK 3 /✓/ <br /> 3 55,77U .n 0. Street Z. l L - rt„AL11 (04--#A <br /> 35x7 r. t t o 3 W, tees d C:! !Un• <br /> �SaFtr' ✓e. ev..t ->Z3.h N, %jid4- h� S Lk <br /> 35 a7i ?r °." 'O .5j-y` 5 t:.K " ❑ Unit <br /> 5a� o_ sveet / Si(,YYy a.Vo ,, S!•n14� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP 917E(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK tmowrORING[REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> hf HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 1f TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTO01BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ton 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,(909) 464-0138 or mall to the <br /> address indicated abcve. <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 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 no% <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$93.00 deposit prior to reviev <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX "INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> VO <br /> wwaw <br /> vuaaas . <br />