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05/03/2006 11:34 209-579-2225 MODESTO ATC PAGE 02 <br /> DAIS RECEIVED PHO LOG NUMBER <br /> SAN 3vAQuuv COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 But Weber Avenue, 3rd Floor, Stockton.,CFA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464.0138 Webt . .sjgov.org/ehdZ351 <br /> P�IBLIC RECORDS RELEASE APPLICATIOAN � <br /> APPLICANT:Iz�yrywA ycey BUSiNESWAGENCY:syl Ar—*SCCw4A'T"t'+�'Se <br /> ADDRESS:1yI.I_ L.Otdt3y P'ALb1nh a.tay IM.e Z�CA <br /> PHONE Ill: ?,C6,IM, 17.71 PHONE(2): FACSIMILE: pri'cs". Z <br /> TENTATIVE"APPOINTMENT DATE: Tama: ?' AA-•. <br /> (Please allow 10 businasa days from"of application submittal•'rwrtnOm only-must bo confirmed) <br /> CHECK BOX TO EXPE R E Trr�$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT U DATE a_ <br /> UNIT DISTRIBUTION O unit 1 0 Unit 2 7unft 7 Una 4 17 Unit 5 pr4tinit 0 0 Omar(sleetrmIcAItftirN s) <br /> FILE ADDRESS EHD USE ONLY <br /> street• .. Street Name city <br /> 1. . lao c t brit <br /> 2. 0 v A <br /> � h <br /> 6. <br /> 7. <br /> 8, <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From yAST to def&= <br /> .y. ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERORouMo TA (UST)CLEANUP SITE(LOP) O NOISING ABATEMENT ItSoLio WASTE FACILRYNEHICLE <br /> OMER CLEANUP SITE(NON-LOP) 0 F000 FACILITY 0 WASTE TWE <br /> ,n UxoemnOUND TAw(MONTromwo RemovAL) 0 DOG KENNEL O DAIRY <br /> R ItAdAROW)S WASTE GENERATOR MCMN:IGN RANCH 0 WASTEWATER TREATMERT PLANT <br /> JSTIEREO PERMITTED FACILITY 0MOTELWTEL O PUMPER TRUCKNAROIGHEM TOILETs <br /> 0 TATTOOMODY PIERCING C1 POOLISPA O LAND USE APPLICATION SIMS <br /> III MEDICAL WAarr.FACILITY 0 OTHER(PLCAsx SPECIFY) <br /> WELL AND SEPTIC PERAUT RECORDS ARE AVAILABLE FOR REvww- MO o"-P=AY 6:OD AM S:DOM - E(CLUOING MOUDAYS. <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(209146$4-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addressos,conlAct <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 confirmed <br /> approximately ten(10) days atter 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 EHD staff Est the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END tsasaoe <br /> v+was <br />