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08/28/2002 15:53 209•-"T9-2225 MODESTO ATC PAGE 01 <br /> �.C1 IU. <br /> SAN'JOAQUIN COUNTYPU13LIC HEALTH SERVIC <br /> ENVIRONMENTAL HEALTH:DIVISION <br /> 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468.3420 ' AUG 2 9 ZOOZ <br /> PUBLIC RECORDS RELEASE`aAPPLICATION <br /> 7PPLICAU�Ti W4 a'A �k C�1 _ �! T C NVIR <br /> PF VIC�Sj 1 <br /> EUSINCSSIAGENCY @ <br /> ADDRESS I l 1.� 1�I G,`wI <br /> ,+�.c-e.,�.r� , 5�, C3 <br /> PHONE FACSIMILE, GQ St ^ Z2 jL <br /> i TENTATIVE"APPOINTMENT DATI; <br /> TIME <br /> (Picasp give i to-10busincss da S from la of�pplicatlon sub�millal) <br /> _�l> } <br /> GHi:CK BOX TO,CXPEDITE REQUEST-$R7.aq FE ST PRO SSED IF!1 BUSINESS DAYS <br /> SIGNATURE OF,C,f,PP1,1CANT ^^ A IP DATE ` . Z'9 <br /> 40_L <br /> p <br /> FILE ADDRESS THIS SIDE CHo STAFF USE ONLY <br /> i. ROGRAM ELEMCNTS SEARCH <br /> I r3 Rgc.d S{pt IC La.•ti ' <br /> 1. 0,A 1 <br /> f <br /> Z Z.SQ Z. S, L k,►. Q <br /> > <br /> IE - <br /> 1 09'J L to ,Q oa <br /> 28 44 S S. "� kk1i <br /> �.'3 S. a.►- QQralw :vtrlaa..K <br /> 1 ., <br /> .,� ENVIRONMENTAL HEALTH DIVISION FILES <br /> �p <br /> NDERGROUND TANK(UST)CLEANUP SITE(COP) d HOUSING ABATEMENT ', C1 SOLID WASTE FACILITY <br /> J OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY SOLID WASTE VEHICLC <br /> C3 UNDERGROUND TANK(MONITORINGlRCMOVAL) 0 DOG KENNEL 0 DAIRY <br /> I ❑ MAzARdOUS WASTE GENE-BATOR O CHICKEN PANCH 0 PKG TREATMENT PLANY <br /> ❑ TIERED PERMIT&D FACILITY ❑ MOTEL ,10TEL ❑ PUMPER TRUCIVYAPOICHEM TOILETS <br /> ❑ TATTO018ODY PSIRCING ❑ POOl1SPA !I ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL wAS'rl_FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List u to ton addresses in the space ll I <br /> • P pa c above. Slilcct the t c s of files r t <br /> yp ( ) from the list abovo b checkitl � <br /> Y 0 � <br /> the appropriate box(cs). At least one file type MUST be selected.' Fax to 209 464-0138 or mail tQ the � <br /> address indicated' above. 1; ! <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."Tile files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. F <br /> 3. A Ric that is actively being worked on by EHD staff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as relcasoci will ibc rco`r#Ianizad by END staff at the expanse <br /> Of the applicant. Future file reviews by the same applleant may rdquirl:a $87.00 deposit prior to review. i <br /> 5. "TENTATIVE appointment dittos must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, t <br /> CONFIRMED APPOINTMENT PO NTMENT DATI~ <br /> TIME <br /> :i i <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW"DATE - <br /> BH <br /> t �i <br />