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e'J/e1/2UU4 ,.12:4/ ... 2UJ-5/9-2225 MODESTO ATC PAGE Ul <br /> DATE RECEIVED EHD LOO NUMBE <br /> (o. / f�, 0 SAN JOAQUIN COUNTY 0 <br /> EL1 '1!� u ENLIAON111TNTALHEALTHDEPARTm-TNT <br /> SEP 0 1 2004 304 E Weber Ave 3`1 Floor ww.corl CA 95205 1985 <br /> (209} 468-3420 Fax: (209) 464-0138 Web:www.cosan-joaquin.caus/ehd <br /> tiVVI ;;iVly ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Pri 4 12 � <br /> APPLICANT: O�Cw 01^ Ot" BUSINESSIAOENCY: ATC <br /> ADDRESS: li\ L,,),&P- palms by Sail-ti Q, Mo�slo <br /> PHONE: 571-11 – -LZn'"t FACSWIL :� --Ir�'�y. s LL2y— <br /> TENTATIVE"APPOINTMENT DATE: �� � "Ay _=TIM,: c) �ol:) <br /> (Phase allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-/REEQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT D A- ^ V�-!r"" _ DATE <br /> Lit Ri ✓' Si S +lAow�• L :l}'IU5f(Ki-0f DeoartMantUse Only <br /> FILE ADDRESS UNIT <br /> 35�� m so.. 5`ia0 oc� tL 14 AZ, .Tl1 ❑ Unit <br /> 2 Sheet 51SI PCXLgLL XV t..AIft- ❑ 5 cat N i– ) <br /> 35ar, cA t�y .L VW /4 7 Sk��k �' S <br /> aL% tam ❑ Unit 2 <br /> tL 6 � <br /> 35x4 <br /> n <br /> 3 507 U a. she Z 1 E. LLN Ca e, a kr3 tti 3 <br /> '35x7 r 77, J%W33 W. Uni <br /> -5z) 7Z30 N, W eik amt S tk <br /> 35a7e ,?' .n glq 5� 5 Ur ❑ Unit <br /> �a-7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ` UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> t2 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILnY ❑ SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL Cl DAJRY <br /> 6f HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> )C TIERED PERMITTED FACILITY ❑ MOTELHOTEL d PUMPER TRUCKJYARD/CHEM TOILETS <br /> ❑ TATTOWBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY CI 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 (209) 464-0138 or mall to tag <br /> address Indicated above. <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 net <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the acme condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same appilcant may require a$93-00 deposit prior to reviev <br /> S. `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 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX ' ` :' INITIALS . <br /> REVIEWED YES NO REVIEW DATE <br /> eHO <br /> ua:-0w <br /> inixoas <br />